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Tikmani SS, Saleem S, Sadia A, M. Bann C, Bozdar MH, Raza J, Dhaded SM, Goudar SS, Gowdar G, Yasmin H, McClure EM, Goldenberg RL. Predictors of Preterm Neonatal Mortality in India and Pakistan: A Secondary Analysis of Data from PURPOSe Study. Glob Pediatr Health 2024; 11:2333794X241236617. [PMID: 38487208 PMCID: PMC10938607 DOI: 10.1177/2333794x241236617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Objective. To create a prediction model for preterm neonatal mortality. Methods. A secondary analysis was conducted using data from a prospective cohort study, the Project to Understand and Research Preterm Pregnancy Outcome South Asia. The Cox proportional hazard model was used and adjusted hazard ratios (AHR) with 95% confidence intervals (95% CI) were reported. Results. Overall, 3446 preterm neonates were included. The mean age of preterm neonates was 0.65 (1.25) hours and 52% were female. The preterm neonatal mortality rate was 23.3%. The maternal factors predicting preterm neonatal death was any antepartum hemorrhage, AHR 1.99 (1.60-2.47), while neonatal predictors were preterm who received positive pressure ventilation AHR 1.30 (1.08-1.57), temperature <35.5°C AHR 1.18 (1.00-1.39), and congenital malformations AHR 3.31 (2.64-4.16). Conclusion. This study identified key maternal and neonatal predictors of preterm neonatal mortality, emphasizing the need for targeted interventions and collaborative public health efforts to address disparities and regional variations.
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Affiliation(s)
| | | | | | - Carla M. Bann
- Research Triangle Institute (RTI) International, Durham, NC, USA
| | | | - Jamal Raza
- National Institute of Child Health, Napier Quarter, Karachi, Pakistan
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Kallapur MG, Ghanchi NK, Harakuni SU, Somannavar MS, Ahmed I, Fogleman E, Hwang K, Kim J, Saleem S, Goudar SS, Tikmani SS, Dhaded SM, Guruprasad G, Yasmin H, Yogeshkumar S, McClure EM, Goldenberg RL. Group B streptococcal prevalence in internal organs and placentas of deceased neonates and stillbirths in South Asia. BJOG 2023; 130 Suppl 3:53-60. [PMID: 37530593 DOI: 10.1111/1471-0528.17614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Group B streptococcus (GBS) has been associated with adverse pregnancy outcomes, but few prospective studies have assessed its prevalence in low- and middle-income country settings. We sought to evaluate the prevalence of GBS by polymerase chain reaction (PCR) in internal organ tissues and placentas of deceased neonates and stillbirths. DESIGN This was a prospective, observational study. SETTING The study was conducted in hospitals in India and Pakistan. POPULATION Pregnant women with stillbirths or preterm births were recruited at delivery, as was a group of women with term, live births, to serve as a control group. METHODS A rectovaginal culture was collected from the women in Pakistan to assess GBS carriage. Using PCR, we evaluated GBS in various tissues of stillbirths and deceased neonates and their placentas, as well as the placentas of live-born preterm and term control infants. MAIN OUTCOME MEASURES GBS identified by PCR in various tissues and the placentas; rate of stillbirths and 28-day neonatal deaths. RESULTS The most obvious finding from this series of analyses from India and Pakistan was that no matter the country, the condition of the subject, the tissue studied or the methodology used, the prevalence of GBS was low, generally ranging between 3% and 6%. Among the risk factors evaluated, only GBS positivity in primigravidae was increased. CONCLUSIONS GBS diagnosed by PCR was identified in <6% of internal organs of stillbirths and neonatal deaths, and their placentas, and control groups in South Asian sites. This is consistent with other reports from South Asia and is lower than the reported GBS rates from the USA, Europe and Africa.
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Affiliation(s)
- Mangala G Kallapur
- Bapuji Educational Association's J.J.M. Medical College, Davangere, Karnataka, India
| | | | - Sheetal U Harakuni
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | | | | | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | - Jean Kim
- RTI International, Durham, North Carolina, USA
| | | | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | | | - Sangappa M Dhaded
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Gowdar Guruprasad
- Bapuji Educational Association's J.J.M. Medical College, Davangere, Karnataka, India
| | | | - S Yogeshkumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
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Yogeshkumar S, Dhananjay S, Gowdar S, Gowdar G, Kulkarni V, Byranahalli S, Goudar SS, Dhaded SM, Somannavar MS, Tikamani SS, Saleem S, Ahmed I, Ghanchi NK, Uddin Z, Yasmin H, Jackson K, McClure EM, Goldenberg RL. Morphological study of the placenta in deliveries with pre-eclampsia: Results from a prospective, observational study in India and Pakistan (PURPOSe). BJOG 2023; 130 Suppl 3:36-42. [PMID: 37530629 DOI: 10.1111/1471-0528.17617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To compare placental findings in women with and without pre-eclampsia. DESIGN The PURPOSe study included women with stillbirths, women with preterm births and women at term as controls. The placenta of each case was evaluated using the Amsterdam criteria. SETTING Two sites and five tertiary care hospitals of south Asia (Three in India and two in Pakistan). POPULATION Pregnancies in India and Pakistan with placental histology including women with documented hypertension and documented proteinuria and women with neither hypertension nor proteinuria. METHODS We compared the placental findings of the two groups using the Amsterdam criteria and further evaluated the placental findings in women with and without pre-eclampsia who had a stillbirth, preterm live birth, or term live birth (control). MAIN OUTCOME MEASURES The main outcome measures were the frequency of maternal and fetal vascular malperfusion and the frequency of placental inflammation and its components, chorioamnionitis, funisitis, villitis and intervillitis in women with and without pre-eclampsia. RESULTS A total of 733 women had pre-eclampsia and 2334 women had neither hypertension nor proteinuria. In the placentas of women with pre-eclampsia, 57.3% had maternal vascular malperfusion compared with 37.1% in women without pre-eclampsia (p < 0.0001). There was not a significant difference in the prevalence of fetal vascular hypertension between mothers with (17.1%) and without (14.8%, p = 0.6118) pre-eclampsia. When placentas were classified as 'histologically normal' or not, 61.3% of those from pre-eclamptic pregnancies were classified as abnormal, whereas if there was no pre-eclampsia, only 45.0% were classified as histologically abnormal (p < 0.0001). We also considered rates of placental maternal vascular malperfusion in women with and without pre-eclampsia with stillbirth, preterm neonatal death, and term live birth. In women at term with no pre-eclampsia, 16.7% of the placentas had features of maternal vascular malperfusion. This occurred in 79.9% of women with stillbirths with pre-eclampsia compared with 51.8% of those without pre-eclampsia. Maternal vascular malperfusion was present in 49.7% of preterm live births with pre-eclampsia compared with 33.8% without pre-eclampsia. We also evaluated the inflammatory lesions by whether the mother had or did not have pre-eclampsia. When all inflammatory lesions were considered, women with pre-eclampsia had significantly fewer inflammatory lesions than those women without pre-eclampsia (17.1% versus 23.6% p = 0.001). Each of the specific inflammatory lesions was less common in placentas of women with pre-eclampsia than those with chorioamnionitis (16.1% versus 21.9%, p = 0.004) and funisitis (1.5% versus. 5.1%, p = 0.0004). CONCLUSIONS Of placental lesions in women with pre-eclampsia, maternal vascular malperfusion was the most common. Inflammatory lesions were less common in women with pre-eclampsia.
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Affiliation(s)
- S Yogeshkumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Shobha Dhananjay
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Sarvamangala Gowdar
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Guruprasad Gowdar
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Vardendra Kulkarni
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Sunil Byranahalli
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Sangappa M Dhaded
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | | | | | | | | | | | | | - Kay Jackson
- RTI International, Durham, North Carolina, USA
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4
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Guruprasad G, Raghoji CR, Dhaded SM, Tikmani SS, Saleem S, Goudar SS, Hwang K, Yogeshkumar S, Somannavar MS, Reza S, Yasmin H, Moore JL, Bann CM, McClure EM, Goldenberg RL. Pregnancy outcomes in preterm multiple gestations: Results from a prospective study in India and Pakistan (PURPOSe). BJOG 2023; 130 Suppl 3:76-83. [PMID: 37470087 DOI: 10.1111/1471-0528.17602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To evaluate perinatal outcomes in preterm multiple compared with singleton pregnancies in India and Pakistan. DESIGN Prospective, observational study. SETTINGS Study hospitals in India and Pakistan. POPULATION We evaluated 3897 preterm pregnancies. These mothers gave birth to 3615 (92.8%) singleton infants, 267 (6.8%) sets of twins, 14 (0.4%) sets of triplets and one set of quadruplets. MAIN OUTCOME MEASURES Neonatal mortality, stillbirth, cause of death. RESULTS Of the singleton infants, 691 (19.1%) were stillborn and 2924 (80.9%) live born. Of the 534 infants from twin pregnancies, 41 (7.7%) were stillborn and 493 (92.3%) were live born. Of the 267 sets of twins, in 14 cases (5.2%) both were stillborn, in 13 cases (4.8%) one was stillborn and one live born, and in 240 cases (90.0%) both were live born. In both preterm twins and preterm singletons, the three most common causes of death were intrauterine hypoxia, infections acquired prior to birth and infections acquired at or after birth. The preterm twins appeared less likely to have died from intrauterine hypoxia but more likely to have died from infections acquired at or after birth. Respiratory distress syndrome (RDS) was less likely considered by the panel to be the primary cause of death in either the twins (9.6%) or singletons (9.7%). Congenital anomalies were also not often judged to be the cause of death in either the preterm twins 2 (2.4%) or singletons 27 (5.3%). CONCLUSION In the PURPOSe study, neonatal mortality rates in preterm twins compared with singletons when evaluated by sex, GA, birthweight and SGA, were generally similar to rates of preterm singleton neonatal mortality in those groups. Thus, the higher rate of mortality in live-born twin infants is related to the fact that these infants were more likely to be born earlier rather than to any inherent characteristics of the babies themselves.
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Affiliation(s)
- Gowdar Guruprasad
- Bapuji Educational Association's J.J.M. Medical College, Karnataka, India
| | - Chaitali R Raghoji
- Bapuji Educational Association's J.J.M. Medical College, Karnataka, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India
| | | | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India
| | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India
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5
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Goldenberg RL, Saleem S, Goudar SS, Moore J, Guruprasad G, Kulkarni V, Dhaded SM, Tikmani SS, Nausheen S, Masheer S, Kallapur MG, Ghanchi NK, Harakuni SU, Ahmed I, Hwang K, Yogeshkumar S, Somannavar MS, Yasmin H, Kim J, Bann CM, Silver RM, McClure EM. The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review. BJOG 2023; 130 Suppl 3:26-35. [PMID: 37592743 DOI: 10.1111/1471-0528.17635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/11/2023] [Indexed: 08/19/2023]
Abstract
The PURPOSe study was a prospective, observational study conducted in India and Pakistan to determine the cause of death for stillbirths and preterm neonatal deaths, using clinical data together with minimally invasive tissue sampling (MITS) and the histologic and polymerase chain reaction (PCR) evaluation of fetal/neonatal tissues and the placenta. After evaluating all available data, an independent panel chose a maternal, a placental and a fetal/neonatal cause of death. Here, we summarise the major results. Among the most important findings were that most stillbirths were caused by fetal asphyxia, often preceded by placental malperfusion, and clinically associated with pre-eclampsia, placental abruption and a small-for-gestational-age fetus. The preterm neonatal deaths were primarily caused by birth asphyxia, followed by various infections. An important finding was that many of the preterm neonatal deaths were caused by a nosocomial infection acquired after neonatal intensive care (NICU) admission; the most common organisms were Acinetobacter baumannii, followed by Klebsiella pneumoniae, Escherichia coli/Shigella and Haemophilus influenzae. Group B streptococcus was less commonly present in the placentas or internal organs of the neonatal deaths.
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Affiliation(s)
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | - Janet Moore
- RTI International, Durham, North Carolina, USA
| | - Gowdar Guruprasad
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Vardendra Kulkarni
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | | | | | | | - Mangala G Kallapur
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | | | - Sheetal U Harakuni
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | | | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | | | - Jean Kim
- RTI International, Durham, North Carolina, USA
| | - Carla M Bann
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
- RTI International, Durham, North Carolina, USA
| | - Robert M Silver
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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Mansukhani R, Shakur-Still H, Chaudhri R, Bello F, Muganyizi P, Kayani A, Javaid K, Okunade O, Olayemi O, Kawala A, Temba R, Bashir A, Geer A, Islam A, Prowse D, Balogun E, Joseph F, Yasmin H, Khakwani M, Mobolaji-Ojibara M, Ghaffar N, Owa O, Jaleel R, Sultana R, Khan S, Magsi S, Abro S, Yasmin S, Munir S, Humayun S, Noor S, Luqman S, Ali S, Afridi U, Tarimo V, Roberts I. Maternal anaemia and the risk of postpartum haemorrhage: a cohort analysis of data from the WOMAN-2 trial. Lancet Glob Health 2023; 11:e1249-e1259. [PMID: 37390833 PMCID: PMC10353972 DOI: 10.1016/s2214-109x(23)00245-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Worldwide, more than half a billion women of reproductive age are anaemic. Each year, about 70 000 women who give birth die from postpartum haemorrhage. Almost all deaths are in low-income or middle-income countries. We examined the association between anaemia and the risk of postpartum haemorrhage. METHODS We did a prospective cohort analysis of data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. This trial enrols women with moderate or severe anaemia giving birth vaginally in hospitals in Pakistan, Nigeria, Tanzania, and Zambia. Moderate anaemia was defined as a haemoglobin concentration of 70-99 g/L and severe anaemia as less than 70 g/L. Hospitals in each country where anaemia in pregnancy is common were identified from a network established during previous obstetric trials. Women who were younger than 18 years without permission provided by a guardian, had a known tranexamic acid allergy, or developed postpartum haemorrhage before the umbilical cord was cut or clamped were excluded from the study. Prebirth haemoglobin, the exposure, was measured after hospital arrival and just before giving birth. Postpartum haemorrhage, the outcome, was defined in three ways: (1) clinical postpartum haemorrhage (estimated blood loss ≥500 mL or any blood loss sufficient to compromise haemodynamic stability); (2) WHO-defined postpartum haemorrhage (estimated blood loss of at least 500 mL); and (3) calculated postpartum haemorrhage (calculated estimated blood loss of ≥1000 mL). Calculated postpartum haemorrhage was estimated from the peripartum change in haemoglobin concentration and bodyweight. We used multivariable logistic regression to examine the association between haemoglobin and postpartum haemorrhage, adjusting for confounding factors. FINDINGS Of the 10 620 women recruited to the WOMAN-2 trial between Aug 24, 2019, and Nov 1, 2022, 10 561 (99·4%) had complete outcome data. 8751 (82·9%) of 10 561 women were recruited from hospitals in Pakistan, 837 (7·9%) from hospitals in Nigeria, 525 (5·0%) from hospitals in Tanzania, and 448 (4·2%) from hospitals in Zambia. The mean age was 27·1 years (SD 5·5) and mean prebirth haemoglobin was 80·7 g/L (11·8). Mean estimated blood loss was 301 mL (SD 183) for the 8791 (83·2%) women with moderate anaemia and 340 mL (288) for the 1770 (16·8%) women with severe anaemia. 742 (7·0%) women had clinical postpartum haemorrhage. The risk of clinical postpartum haemorrhage was 6·2% in women with moderate anaemia and 11·2% in women with severe anaemia. A 10 g/L reduction in prebirth haemoglobin increased the odds of clinical postpartum haemorrhage (adjusted odds ratio [aOR] 1·29 [95% CI 1·21-1·38]), WHO-defined postpartum haemorrhage (aOR 1·25 [1·16-1·36]), and calculated postpartum haemorrhage (aOR 1·23 [1·14-1·32]). 14 women died and 68 either died or had a near miss. Severe anaemia was associated with seven times higher odds of death or near miss (OR 7·25 [95% CI 4·45-11·80]) than was moderate anaemia. INTERPRETATION Anaemia is strongly associated with postpartum haemorrhage and the risk of death or near miss. Attention should be given to the prevention and treatment of anaemia in women of reproductive age. FUNDING The WOMAN-2 trial is funded by Wellcome and the Bill & Melinda Gates Foundation.
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Harakuni SU, Somannavar MS, Ghanchi NK, Ahmed I, Zafar A, Kim J, Tikmani SS, Hwang K, Saleem S, Goudar SS, Dhaded S, Guruprasad G, Yasmin H, Yogeshkumar S, Aceituno A, Silver RM, McClure EM, Goldenberg RL. Pathogens identified in the internal tissues and placentas of stillbirths: results from the prospective, observational PURPOSe study. BJOG 2023. [PMID: 37069731 DOI: 10.1111/1471-0528.17479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/18/2022] [Accepted: 12/06/2022] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To examine internal organ tissues and placentas of stillbirths for various pathogens. DESIGN Prospective, observational study. SETTINGS Three study hospitals in India and a large maternity hospital in Pakistan. POPULATION Stillborn infants delivered in a study hospital. METHODS A prospective observational study. MAIN OUTCOME MEASURES Organisms identified by pathogen polymerase chain reaction (PCR) in internal organs and placental tissues of stillbirths. RESULTS Of 2437 stillbirth internal tissues, 8.3% (95% CI 7.2-9.4) were positive. Organisms were most commonly detected in brain (12.3%), cerebrospinal fluid (CSF) (9.5%) and whole blood (8.4%). Ureaplasma urealyticum/parvum was the organism most frequently detected in at least one internal organ (6.4% of stillbirths and 2% of all tissues). Escherichia coli/Shigella was the next most common (4.1% one or more internal organ tissue sample and 1.3% of tissue samples), followed by Staphylococcus aureus in at least one internal organ tissue (1.9% and 0.9% of all tissues). None of the other organisms was found in more than 1.4% of the tissue samples in stillbirths or more than 0.6% of the internal tissues examined. In the placenta tissue, membrane or cord blood combined, 42.8% (95% CI 40.2-45.3) had at least one organism identified, with U. urealyticum/parvum representing the most commonly identified (27.8%). CONCLUSIONS In about 8% of stillbirths, there was evidence of a pathogen in an internal organ. Ureaplasma urealyticum/parvum was the most common organism found in the placenta and in the internal tissues, especially in the fetal brain.
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Affiliation(s)
- S U Harakuni
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | - M S Somannavar
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | | | - I Ahmed
- Aga Khan University, Karachi, Pakistan
| | - A Zafar
- Aga Khan University, Karachi, Pakistan
| | - J Kim
- RTI International, Durham, North Carolina, USA
| | | | - K Hwang
- RTI International, Durham, North Carolina, USA
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
- RTI International, Durham, North Carolina, USA
| | - S S Goudar
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | - S Dhaded
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | - G Guruprasad
- Bapuji Educational Association's J.J.M. Medical College, Davangere, India
| | - H Yasmin
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - S Yogeshkumar
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | - A Aceituno
- RTI International, Durham, North Carolina, USA
| | - R M Silver
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - E M McClure
- RTI International, Durham, North Carolina, USA
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Feroz AS, Meghani SN, Yasmin H, Saleem S, Bhutta Z, Arshad H, Seto E. Exploring Caregivers' Perspectives and Perceived Acceptability of a Mobile-Based Telemonitoring Program to Support Pregnant Women at High-Risk for Preeclampsia in Karachi, Pakistan: A Qualitative Descriptive Study. Healthcare (Basel) 2023; 11:healthcare11030392. [PMID: 36766967 PMCID: PMC9914365 DOI: 10.3390/healthcare11030392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Very little is known about the perspectives of the caregivers on the use of telemonitoring (TM) interventions in low-middle-income countries. Understanding caregivers' perspectives on TM interventions is crucial, given that caregiving activities are correlated with the social, emotional, and clinical outcomes among pregnant women. This study aims to explore caregivers' perspectives and perceived acceptability of a mobile phone-based TM program to support pregnant women at high-risk for preeclampsia. A qualitative description design was used to conduct and analyze 28 semi-structured interviews with a diverse group of caregivers. The study was conducted at the Jinnah Post Graduate Medical Center, Karachi, Pakistan. The caregivers were identified through purposive sampling and additional caregivers were interviewed until the point of data saturation. The conventional content analysis technique was used to analyze digital audio recordings of the caregiver interviews. All caregivers embraced the proposed mobile phone-based TM program because they perceived many benefits, including a reduction in caregivers' anxiety and workload, increased convenience, and cost-effectiveness. However, the caregivers cited several caveats to the future implementation of the TM program including the inability of some women and caregivers to use the TM program and the poor acceptance of the TM system among less educated and non-tech savvy families. Our study recommends developing a TM program to reduce the caregiver stress and workload, designing a context-specific TM program using a user-centric approach, training caregivers on the use of the TM program, sensitizing caregivers on the benefits of the TM program, and developing a low-cost TM program to maximize access.
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Affiliation(s)
- Anam Shahil Feroz
- Community Health Sciences Department, Aga Khan University, Karachi 74800, Sindh, Pakistan
- Institute of Health Policy Management and Evaluation, The University of Toronto, Toronto, ON M5T 3M6, Canada
- Correspondence: ; Tel.: +1-647-867-6702
| | - Salima Nazim Meghani
- School of Nursing & Midwifery, The Aga Khan University, Karachi 74800, Sindh, Pakistan
| | - Haleema Yasmin
- Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Center, Karachi 75510, Sindh, Pakistan
| | - Sarah Saleem
- Community Health Sciences Department, Aga Khan University, Karachi 74800, Sindh, Pakistan
| | - Zulfiqar Bhutta
- Centre for Global Child Health, SickKids, Toronto, ON M5G 1X8, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Sindh, Pakistan
- Dalla Lana School of Public Health, The University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Hajraa Arshad
- Medical College, Aga Khan University, Karachi 74800, Sindh, Pakistan
| | - Emily Seto
- Institute of Health Policy Management and Evaluation, The University of Toronto, Toronto, ON M5T 3M6, Canada
- Centre for Digital Therapeutics, University Health Network, Toronto, ON M5G 2C4, Canada
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Shahil Feroz A, Yasmin H, Saleem S, Bhutta Z, Seto E. Feasibility of implementing a mobile phone-based telemonitoring programme to support pregnant women at high-risk for pre-eclampsia in Karachi, Pakistan: protocol for a mixed-methods study. BMJ Open 2022; 12:e070535. [PMID: 36585144 PMCID: PMC9809301 DOI: 10.1136/bmjopen-2022-070535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION High maternal mortality from pre-eclampsia/eclampsia results from lack of early identification and management of pregnant women at high-risk for pre-eclampsia. A potential tool to support pregnant women at high-risk for pre-eclampsia is telemonitoring. There is limited evidence on the use and effectiveness of telemonitoring for pregnant women in low-income and middle-income countries (LMICs) which limits the understanding of the process and mechanisms through which the intervention works in LMICs. This study will explore the feasibility of implementing a mobile phone-based telemonitoring programme for pregnant women at high-risk for pre-eclampsia in Karachi, Pakistan. METHODS AND ANALYSIS A convergent mixed-methods study will be conducted at the Jinnah Postgraduate Medical Center (JPMC) in Karachi, Pakistan. This study will recruit 50 pregnant women at high-risk for pre-eclampsia to assess clinical feasibility across the five foci of Bowen's framework including acceptability, demand, implementation, practicality and limited-efficacy testing. Data sources will include semi-structured interviews with the enrolled women, caregivers and clinicians, as well as quantitative data from paper medical records, research logs and server data. The quantitative and qualitative data will be analysed separately and then integrated at the interpretation and reporting levels to advance our understanding of the telemonitoring programme's feasibility across the five areas of Bowen's framework. ETHICS AND DISSEMINATION Ethics approvals have been obtained from JPMC, the National Bioethics Committee of Pakistan, University Health Network, Aga Khan University and the University of Toronto. The study results will be disseminated to the scientific community through publications and conference presentations. Findings of the study will provide evidence on the feasibility of using a telemonitoring programme where pregnant women at high-risk for pre-eclampsia in Pakistan will take their own blood pressure readings at home. Lessons learnt in this feasibility trial will be used to determine the appropriateness of a future effectiveness trial. TRIAL REGISTRATION NUMBER NCT05662696.
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Affiliation(s)
- Anam Shahil Feroz
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Community Health Sciences Department, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Haleema Yasmin
- Obstetrics and Gynaecology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Sarah Saleem
- Community Health Sciences Department, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Zulfiqar Bhutta
- Division of Women and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Global Child Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Kabir E, Haque Tanisha M, Hossain Sagar B, Mollika R, Khan T, Chowdhury N, Yasmin H, Khair N, Quadir M, Mustafa N. 440P Targeting KRASG12C: Repurposing of potential therapeutics for the treatment of pancreatic ductal adenocarcinoma (PDAC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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11
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Dhaded SM, Saleem S, Goudar SS, Tikmani SS, Hwang K, Guruprasad G, Aradhya GH, Kusagur VB, Patil LGC, Yogeshkumar S, Somannavar MS, Reza S, Roujani S, Raza J, Yasmin H, Aceituno A, Parlberg L, Kim J, Moore J, Bann CM, Silver RM, Goldenberg RL, McClure EM. The causes of preterm neonatal deaths in India and Pakistan (PURPOSe): a prospective cohort study. Lancet Glob Health 2022; 10:e1575-e1581. [PMID: 36240824 PMCID: PMC9579353 DOI: 10.1016/s2214-109x(22)00384-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/17/2022] [Accepted: 08/22/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Preterm birth remains the major cause of neonatal death worldwide. South Asia contributes disproportionately to deaths among preterm births worldwide, yet few population-based studies have assessed the underlying causes of deaths. Novel evaluations, including histological and bacteriological assessments of placental and fetal tissues, facilitate more precise determination of the underlying causes of preterm deaths. We sought to assess underlying and contributing causes of preterm neonatal deaths in India and Pakistan. METHODS The project to understand and research preterm pregnancy outcomes and stillbirths in South Asia (PURPOSe) was a prospective cohort study done in three hospitals in Davangere, India, and two hospitals in Karachi, Pakistan. All pregnant females older than 14 years were screened at the time of presentation for delivery, and those with an expected or known preterm birth, defined as less than 37 weeks of gestation, were enrolled. Liveborn neonates with a weight of 1000 g or more who died by 28 days after birth were included in analyses. Placentas were collected and histologically evaluated. In addition, among all neonatal deaths, with consent, minimally invasive tissue sampling was performed for histological analyses. PCR testing was performed to assess microbial pathogens in the placental, blood, and fetal tissues collected. An independent panel reviewed available data, including clinical description of the case and all clinical maternal, fetal, and placental findings, and results of PCR bacteriological investigation and minimally invasive tissue sampling histology, from all eligible preterm neonates to determine the primary and contributing maternal, placental, and neonatal causes of death. FINDINGS Between July 1, 2018, and March 26, 2020, of the 3470 preterm neonates enrolled, 804 (23%) died by 28 days after birth, and, of those, 615 were eligible and had their cases reviewed by the panel. Primary maternal causes of neonatal death were hypertensive disease (204 [33%] of 615 cases), followed by maternal complication of pregnancy (76 [12%]) and preterm labour (76 [11%]), whereas the primary placental causes were maternal and fetal vascular malperfusion (172 [28%] of 615) and chorioamnionitis, funisitis, or both (149 [26%]). The primary neonatal cause of death was intrauterine hypoxia (212 [34%] of 615) followed by congenital infections (126 [20%]), neonatal infections (122 [20%]), and respiratory distress syndrome (126 [20%]). INTERPRETATION In south Asia, intrauterine hypoxia and congenital infections were the major causes of neonatal death among preterm babies. Maternal hypertensive disorders and placental disorders, especially maternal and fetal vascular malperfusion and placental abruption, substantially contributed to these deaths. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sangappa M Dhaded
- KLE Academy of Higher Education and Research, JN Medical College, Belagavi, Karnataka, India
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, JN Medical College, Belagavi, Karnataka, India
| | | | - Kay Hwang
- Research Triangle Institute International, Durham, NC, USA
| | - Gowdar Guruprasad
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Gayathri H Aradhya
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Varun B Kusagur
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | | | - S Yogeshkumar
- KLE Academy of Higher Education and Research, JN Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research, JN Medical College, Belagavi, Karnataka, India
| | - Sayyeda Reza
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sana Roujani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | | | - Anna Aceituno
- Research Triangle Institute International, Durham, NC, USA
| | | | - Jean Kim
- Research Triangle Institute International, Durham, NC, USA
| | - Janet Moore
- Research Triangle Institute International, Durham, NC, USA
| | - Carla M Bann
- Research Triangle Institute International, Durham, NC, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Elizabeth M McClure
- Research Triangle Institute International, Durham, NC, USA,Correspondence to: Dr Elizabeth M McClure, Research Triangle Institute International, Durham, NC 27709, USA
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12
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Zohra N, Munim S, Ijaz S, Baqai S, Yasmin H, Korejo R, CC L. Society of Obstetricians and Gynecologists Pakistan Guideline on Second Trimester Anomaly Scan. Pak J Med Sci 2022; 38:2039-2042. [PMID: 36246714 PMCID: PMC9532665 DOI: 10.12669/pjms.38.7.6212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/27/2022] [Accepted: 07/06/2022] [Indexed: 11/15/2022] Open
Abstract
The Guideline on Second trimester anomaly scan has been prepared by the National Maternal Fetal Medicine guidelines committee, approved by the Society of Obstetricians and Gynecologists Pakistan. These guidelines are developed in 2022 and will be reviewed after two years.The current document provides guidance about the importance of second trimester scan to practicing clinicians and sonologists. It will enable them to offer it timely offer to their patient this scan and refer them to the Fetal medicine specialist when indicated. It is unique as the document is modified according to local needs. The Guidelines are developed in 2022 and will be reviewed after two years.
doi: https://doi.org/10.12669/pjms.38.7.6212
How to cite this:Zohra N, Munim S, Ijaz S, Baqai S, Yasmin H, Korejo R, et al. Society of Obstetricians and Gynecologists Pakistan Guideline on Second Trimester Anomaly Scan. Pak J Med Sci. 2022;38(7):---------. doi: https://doi.org/10.12669/pjms.38.7.6212
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Nishat Zohra
- Nishat Zohra, Isra University Hyderabad, Pakistan
- Correspondence: Prof. Nishat Zohra, Department of Obstetrics and Gynecology, Consultant Fetal Medicine, Isra University, Hyderabad, Pakistan.
| | - Shama Munim
- ShamaMunim, Jinnah Medical and Dental University, Karachi, Pakistan
| | - Shamila Ijaz
- Shamila Ijaz, Allama Iqbal Medical College, Lahore, Pakistan
| | - Shehla Baqai
- Shehla Baqai, CMH Lahore Medical College, Lahore, Pakistan
| | - Haleema Yasmin
- Haleema Yasmin, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Razia Korejo
- Razia Korejo, Baharia University, Karachi, Pakistan
| | - Lees CC
- Lees CC, Imperial College London, UK
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McClure EM, Saleem S, Goudar SS, Tikmani SS, Dhaded SM, Hwang K, Guruprasad G, Shobha D, Sarvamangala B, Yogeshkumar S, Somannavar MS, Roujani S, Reza S, Raza J, Yasmin H, Aceituno A, Parlberg L, Kim J, Bann CM, Silver RM, Goldenberg RL. The causes of stillbirths in south Asia: results from a prospective study in India and Pakistan (PURPOSe). Lancet Glob Health 2022; 10:e970-e977. [PMID: 35714647 PMCID: PMC9210259 DOI: 10.1016/s2214-109x(22)00180-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Kay Hwang
- Research Triangle Institute International, Durham, NC, USA
| | - Gowdar Guruprasad
- Department of Neonatology, Bapuji Educational Association's JJM Medical College, Davangere, India
| | - Dhananjaya Shobha
- Department of Obstetrics, Bapuji Educational Association's JJM Medical College, Davangere, India
| | - B Sarvamangala
- Department of Obstetrics, Bapuji Educational Association's JJM Medical College, Davangere, India
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Sana Roujani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sayyeda Reza
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Anna Aceituno
- Research Triangle Institute International, Durham, NC, USA
| | | | - Jean Kim
- Research Triangle Institute International, Durham, NC, USA
| | - Carla M Bann
- Research Triangle Institute International, Durham, NC, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Naz R, Gul F, Zahoor S, Nosheen A, Yasmin H, Keyani R, Shahid M, Hassan MN, Siddiqui MH, Batool S, Anwar Z, Ali N, Roberts TH. Interactive effects of hydrogen sulphide and silicon enhance drought and heat tolerance by modulating hormones, antioxidant defence enzymes and redox status in barley (Hordeum vulgare L.). Plant Biol (Stuttg) 2022; 24:684-696. [PMID: 34879172 DOI: 10.1111/plb.13374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/08/2021] [Indexed: 05/28/2023]
Abstract
Recent changes in climate have reduced crop productivity throughout much of the world. Drought and heat stress, particularly in arid and semi-arid regions, have seriously affected barley production. This study explored the separate and interactive effects of silicon (Si) and hydrogen sulphide (H2 S) on plant growth and mitigation of the adverse effects of heat stress (DS) and drought stress (HS) in a barley pot experiment. The impacts of simultaneous DS + HS were more severe than individual stresses due to increased ROS production, malondialdehyde (MDA) content and higher electrolyte leakage (EL), thereby leading to reduced water, protein and photosynthetic pigment content. Exogenously applied Si and H2 S alleviated the DS-, HS- and DS + HS-induced effects on barley by reducing ROS production, MDA and EL. A single application of H2 S or Si + H2 S increased plant biomass under all stress conditions, which can be ascribed to higher Si accumulation in barley shoots. A single application of Si or H2 S significantly increased plant biomass. However, Si + H2 S was the most effective treatment for metabolite accumulation and elevating activity of antioxidant enzymes to prevent toxicity from oxidative stress. This treatment also modulated osmolyte content, enhanced antioxidant activity and regulated the stress signalling-related endogenous hormones, abscisic acid (ABA) and indole acetic acid (IAA). Exogenous treatments regulated endogenous H2 S and Si and resulted in higher tolerance to individual and combined drought and heat stress in barley.
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Affiliation(s)
- R Naz
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - F Gul
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - S Zahoor
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - A Nosheen
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - H Yasmin
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - R Keyani
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - M Shahid
- Department of Environmental Sciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - M N Hassan
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - M H Siddiqui
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - S Batool
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Z Anwar
- Department of Computer Science, COMSATS University Islamabad, Islamabad, Pakistan
| | - N Ali
- Department of Computer Science, COMSATS University Islamabad, Islamabad, Pakistan
| | - T H Roberts
- School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
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15
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Goldenberg RL, Dhaded S, Saleem S, Goudar SS, Tikmani SS, Trotta M, Hwang Jackson K, Guruprasad G, Kulkarni V, Kumar S, Uddin Z, Reza S, Raza J, Yasmin H, Yogeshkumar S, Somannavar MS, Aceituno A, Parlberg L, Silver RM, McClure EM. Birth asphyxia is under-rated as a cause of preterm neonatal mortality in low- and middle-income countries: A prospective, observational study from PURPOSe. BJOG 2022; 129:1993-2000. [PMID: 35593030 DOI: 10.1111/1471-0528.17220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/19/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess respiratory distress syndrome (RDS) compared with birth asphyxia as the cause of death in preterm newborns, assigned by the neonatal intensive care unit (NICU) physician at the time of death and assigned by a panel with complete obstetric history, placental evaluation, tissue histology and microbiology. DESIGN Prospective, observational study. SETTINGS Study NICUs in India and Pakistan. POPULATION Preterm infants delivered in study facility. METHODS A total of 410 preterm infants who died in the NICU with cause of death ascertained by the NICU physicians and independently by expert panels. We compared the percentage of cases assigned RDS versus birth asphyxia as cause of death by the physician and the panel. MAIN OUTCOME MEASURES RDS and birth asphyxia. RESULTS Of 410 preterm neonatal deaths, the discharging NICU physicians found RDS as a cause of death among 83.2% of the cases, compared with the panel finding RDS in only 51.0%. In the same neonatal deaths, the NICU physicians found birth asphyxia as a cause of death in 14.9% of the deaths, whereas the panels found birth asphyxia in 57.6% of the deaths. The difference was greater in Pakistan were the physicians attributed 89.7% of the deaths to RDS and less than 1% to birth asphyxia whereas the panel attributed 35.6% of the deaths to RDS and 62.7% to birth asphyxia. CONCLUSIONS NICU physicians who reported cause of death in deceased preterm infants less often attributed the death to birth asphyxia, and instead more often chose RDS, whereas expert panels with more extensive data attributed a greater proportion of deaths to birth asphyxia than did the physicians.
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Affiliation(s)
| | - Sangappa Dhaded
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, India
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, India
| | | | | | | | - Gowder Guruprasad
- Bapuji Educational Association's, J.J.M. Medical College, Davangere, India
| | - Vardendra Kulkarni
- Bapuji Educational Association's, J.J.M. Medical College, Davangere, India
| | - Sunil Kumar
- Bapuji Educational Association's, J.J.M. Medical College, Davangere, India
| | | | | | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | | | - S Yogeshkumar
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, India
| | | | | | | | - Robert M Silver
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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Munim S, Islam Z, Zohra N, Yasmin H, Korejo R. Guidelines on prevention of preterm birth. J Matern Fetal Neonatal Med 2022; 35:9527-9531. [PMID: 35240915 DOI: 10.1080/14767058.2022.2045582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This guideline has been prepared by the National Maternal Fetal Medicine guidelines committee and approved by the Society of Obstetricians and Gynecologists Pakistan. These recommendations will enable the practicing clinicians to optimally manage pregnancies at risk of preterm birth.
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Affiliation(s)
- Shama Munim
- Department of Obstetrics and Gynecology & Fetal Medicine, Jinnah Medical and Dental University, Karachi, Pakistan
| | - Zaheena Islam
- Department of Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Nishat Zohra
- Department of Obstetrics and Gynecology, Isra University Hyderabad, Hyderabad, Sindh, Pakistan
| | - Haleema Yasmin
- Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Razia Korejo
- Department of Obstetrics and Gynecology, Baharia University, Karachi, Pakistan
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Sheikh MA, Fawad A, Rabbani KJ, Mazhar SB, Ali S, Yasmin H, Khalid SE, Niaz WA, Quddusi H, Anwer MA, Gul B, Qazi SM. Overactive bladder: A multicenter study in Pakistan. J PAK MED ASSOC 2022; 72:17-21. [PMID: 35099431 DOI: 10.47391/jpma.20-1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the overall prevalence of overactive bladder in Pakistan, and to determine the difference in prevalence in relation to gender. Methods The multicenter study was conducted from February 2017 to October 2018 at 11 institutions across the country, and comprised randomly selected healthy subjects of either gender who were assessed on the basis of symptoms defined by the International Continence Society for overactive bladder. Data was collected using a questionnaire based on the symptoms which was filled for the respondent by designated health workers. Data was analysed using SPSS 23. RESULTS Of the 1291 respondents, 632(49%) were males with a mean age of 37.8±14.4 years, and 659(51%) were females with a mean age of 38.3±13.7 years. The overall prevalence of overactive bladder was 82(6.4%). Among the males, it was 15(2.4%) and among the females 67(10.2%) (p=0.001). Urgency, frequency and nocturia were reported by 82(6.4%) respondents; 15(1.2%) males and 67(5.2%) females (p=0.001). CONCLUSIONS The prevalence of overactive bladder was found to be low when assessed with strict application.
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Affiliation(s)
| | - Ahmed Fawad
- Department of Urology, Ziauddin University, Karachi, Pakistan
| | | | - Syeda Batool Mazhar
- Department of Gynaecology and Obstetrics, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, Pakistan
| | - Shahzad Ali
- Department of Urology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Haleema Yasmin
- Department of Gynaecology and Obstetrics, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | | | - Waqar Azim Niaz
- Department of Urology, and Transplant Surgery, Quaid e Azam International Hospital, Islamabad, Pakistan
| | - Humma Quddusi
- Department of Gynaecology and Obstetrics, Nishter Medical University, Multan, Pakistan
| | | | - Bakhtawar Gul
- Department of Urology, Institute of Kidney Diseases, Hayatabad, Peshawar, Pakistan
| | - Sajid Mumtaz Qazi
- Department of Urology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
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Yasmin H, Sadia A, Qamar A, Shahil Feroz A. Exploring healthcare providers' perceptions of mental health amid COVID-19 pandemic in obstetrics and gynaecology department of a tertiary care public sector hospital of Karachi, Pakistan: an exploratory qualitative study protocol. BMJ Open 2021; 11:e054010. [PMID: 34880024 PMCID: PMC8655342 DOI: 10.1136/bmjopen-2021-054010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In the wake of the unprecedented public health challenge of the COVID-19 pandemic, it is highly significant to recognise the mental health impact of this mounting threat on healthcare providers (HCPs) working in the obstetrics and gynaecology department. Experience from epidemics and emerging literature around COVID-19 show that the unparalleled amount of stress that HCPs are dealing with is linked with the increased burden of mental health conditions. We aim to conduct an exploratory qualitative descriptive study to assess HCPs' perceptions of mental health amid the COVID-19 pandemic in the obstetrics and gynaecology department of a public sector tertiary care hospital of Karachi, Pakistan. METHODS AND ANALYSIS This study will use a qualitative descriptive approach where approximately 20-25 HCPs from the obstetrics and gynaecology department will be recruited using a purposive sampling approach. Data will be collected through semistructured interviews and it will be analysed thematically using NVivo V.12 Plus software. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the Institutional Review Board Committee of Jinnah Postgraduate Medical Center hospital. The study results will be disseminated to the scientific community and the HCPs participating in the study. The findings will help us to explore the doctor's perceptions of mental health during the current pandemic of COVID-19 and its impact on their daily lives and mental well-being.
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Affiliation(s)
- Haleema Yasmin
- Obstetrics and Gynaecology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Afreen Sadia
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Areesha Qamar
- Obstetrics and Gynaecology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Anam Shahil Feroz
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Sohail R, Yasmin H, Tasneem N, Khanum Z, Sachdeve PS, Pal SA, Zubair M, Fahim F, Ali S, Ahmed R. The Prevalence of Subclinical Hypothyroidism During Early Pregnancy in Pakistan: A Cross-Sectional Study. Cureus 2021; 13:e20316. [PMID: 35028215 PMCID: PMC8747977 DOI: 10.7759/cureus.20316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Subclinical hypothyroidism (SCH) during early pregnancy is associated with an increased risk of miscarriage or premature birth. In Pakistan, the prevalence of SCH among pregnant women is not well documented. This multi-center study aims at identifying the prevalence of SCH among Pakistani pregnant women. Methods A cross-sectional multi-center study was conducted over a period of 12 months. Pregnant females in the first trimester of pregnancy were recruited from the antenatal clinics of seven centers from six Pakistani cities. We assessed the frequency of SCH in pregnant females and associated risk factors. Results A total of 500 pregnant women were enrolled in this study. Only eight women (1.6%) had a newly-diagnosed SCH. While 1.2% of women had hyperthyroidism, 6% had known hypothyroidism, and 1% had overt hypothyroidism. Ten females (33.3%) with known hypothyroidism were receiving an inadequate dose of thyroid replacement therapy. The association between BMI and SCH was not statistically significant (p = 0.69). Moreover, we could not find any significant difference between patients with or without SCH in terms of age (p > 0.90), dyslipidemia (p = 0.157), history of miscarriage (p > 0.90), the regularity of the cycle (p > 0.90), and history of infertility (p > 0.90). Conclusions The frequency of undiagnosed SCH in pregnant females in the study from Pakistan was 1.6%. The rate of uncontrolled hypothyroidism was high, which raises an alarm of the potential risks of untreated thyroid disorder.
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Affiliation(s)
- Rubina Sohail
- Obstetrics and Gynecology, Services Institute of Medical Sciences, Lahore, PAK
| | - Haleema Yasmin
- Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Nasira Tasneem
- Obstetrics and Gynecology, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Zohra Khanum
- Obstetrics and Gynecology, Sir Ganga Ram Hospital, Lahore, PAK
| | | | - Sadiah A Pal
- Obstetrics and Gynecology, Medicell Clinic, Karachi, PAK
| | - Maryam Zubair
- Obstetrics and Gynecology, Azad Jammu Kashmir Medical College, Muzaffarabad, PAK
| | - Fauzia Fahim
- Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, PAK
| | - Sobia Ali
- Medical Affairs, Abbott Laboratories (Pakistan) Limited, Karachi, PAK
| | - Raeefuddin Ahmed
- Medical Affairs, Abbott Laboratories (Pakistan) Limited, Karachi, PAK
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Goldenberg RL, Saleem S, Goudar SS, Silver RM, Tikmani SS, Guruprasad G, Dhaded SM, Yasmin H, Bano K, Somannavar MS, Yogeshkumar S, Hwang K, Aceituno A, Parlberg L, McClure EM. Preventable stillbirths in India and Pakistan: a prospective, observational study. BJOG 2021; 128:1762-1773. [PMID: 34173998 DOI: 10.1111/1471-0528.16820] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Stillbirths occur 10-20 times more frequently in low-income settings compared with high-income settings. We created a methodology to define the proportion of stillbirths that are potentially preventable in low-income settings and applied it to stillbirths in sites in India and Pakistan. DESIGN Prospective observational study. SETTING Three maternity hospitals in Davangere, India and a large public hospital in Karachi, Pakistan. POPULATION All cases of stillbirth at ≥20 weeks of gestation occurring from July 2018 to February 2020 were screened for participation; 872 stillbirths were included in this analysis. METHODS We prospectively defined the conditions and gestational ages that defined the stillbirth cases considered potentially preventable. Informed consent was sought from the parent(s) once the stillbirth was identified, either before or soon after delivery. All information available, including obstetric and medical history, clinical course, fetal heart sounds on admission, the presence of maceration as well as examination of the stillbirth after delivery, histology, and polymerase chain reaction for infectious pathogens of the placenta and various fetal tissues, was used to assess whether a stillbirth was potentially preventable. MAIN OUTCOME MEASURES Whether a stillbirth was determined to be potentially preventable and the criteria for assignment to those categories. RESULTS Of 984 enrolled, 872 stillbirths at ≥20 weeks of gestation met the inclusion criteria and were included; of these, 55.5% were deemed to be potentially preventable. Of the 649 stillbirths at ≥28 weeks of gestation and ≥1000 g birthweight, 73.5% were considered potentially preventable. The most common conditions associated with a potentially preventable stillbirth at ≥28 weeks of gestation and ≥1000 g birthweight were small for gestational age (SGA) (52.8%), maternal hypertension (50.2%), antepartum haemorrhage (31.4%) and death that occurred after hospital admission (15.7%). CONCLUSIONS Most stillbirths in these sites were deemed preventable and were often associated with maternal hypertension, antepartum haemorrhage, SGA and intrapartum demise. TWEETABLE ABSTRACT Most stillbirths are preventable by better care for women with hypertension, growth restriction and antepartum haemorrhage.
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Affiliation(s)
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | - S S Goudar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, India
| | - R M Silver
- University of Utah, Salt Lake City, UT, USA
| | | | | | - S M Dhaded
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, India
| | - H Yasmin
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - K Bano
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - M S Somannavar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, India
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, India
| | - K Hwang
- RTI International, Durham, NC, USA
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Masood S, Baqai S, Naheed F, Masood Y, Sikandar R, Chaudhri R, Yasmin H, Korejo R. Guidelines for management of hyperglycemia in pregnancy (HIP) by Society of Obstetricians & Gynaecologists of Pakistan (SOGP) #. J Diabetol 2021. [DOI: 10.4103/jod.jod_88_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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Tikmani SS, Roujani S, Azam SI, Yasmin H, Bano K, Jessani S, Reza S, McClure EM, Goldenberg RL, Saleem S. Relationship Between Foot Length and Gestational Age in Pakistan. Glob Pediatr Health 2020; 7:2333794X20974206. [PMID: 33283027 PMCID: PMC7683835 DOI: 10.1177/2333794x20974206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022] Open
Abstract
Preterm births have a high risk of mortality. Therefore, knowledge of the gestational age (GA) at birth is crucial to guide the appropriate management of a newborn. Common methods for estimating GA such as the last menstrual period, ultrasonography, and post-natal Ballard scoring have some limitations. This study aimed to determine the relationship between foot length and GA to develop and validate an equation for predicting GA of Pakistani newborns. We conducted a prospective study in a large obstetric hospital in Pakistan. Data for this analysis were extracted from the hospital files of eligible women by trained study midwives. Midwives were also trained in performing the Ballard examination and taking foot length using a disposable measuring tape within an hour of the birth. The GA was calculated using an android-based GA calculator. Simple and multiple linear regression were used to construct predicting equations for GA. Both the foot length and GA were available for 1542 cases. The median GA was 34.5 (IQR 4.7) weeks and the median foot length was 7 cm (IQR 1.4). There was a positive linear relationship between foot length and GA (r2 81.7%, P-value < .001). Stratified analysis showed an r2 of 81.7% for males and 81.6% for females. The r2 for stillbirths was 84.1% and, 82.3% for live births. The r2 for macerated stillbirths was 88.6% and 90.6% for fresh stillbirths. In resource poor settings, the use of foot length can estimate GA in both live births and stillbirths and can easily identify preterm infants.
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Affiliation(s)
| | | | | | - Haleema Yasmin
- Jinnah Postgraduate Medical Center, Karachi, Sindh, Pakistan
| | - Khadija Bano
- Jinnah Postgraduate Medical Center, Karachi, Sindh, Pakistan
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Yasmin H, Toia B, Axell R, Aleksejeva K, Pakzad M, Hamid R, Ockrim J, Greenwell T. Patient factors affect radiation exposure during video urodynamics. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Feroz A, Ali AS, Ibrahim MN, McClure EM, Tikmani SS, Reza S, Abbasi Z, Raza J, Yasmin H, Bano K, Zafar A, Siddiqi S, Goldenberg RL, Saleem S. Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study. Matern Health Neonatol Perinatol 2019; 5:17. [PMID: 31666979 PMCID: PMC6814094 DOI: 10.1186/s40748-019-0112-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals’ attitudes and perceptions related to MITS. Methods A qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software. Results A total of 12 interviews (FGDs = 4; KIIs = 8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS. Conclusions This formative research provided a unique opportunity to explore health professionals’ views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings.
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Affiliation(s)
- Anam Feroz
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Anum Shiraz Ali
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | | | | | - Shiyam Sunder Tikmani
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Sayyeda Reza
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Zahid Abbasi
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Jamal Raza
- 2National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- 4Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Khadija Bano
- 4Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Afia Zafar
- 5Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Sameen Siddiqi
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Robert L Goldenberg
- 6Department of Obstetrics and Gynecology, Columbia University, New York, USA
| | - Sarah Saleem
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
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Feroz A, Ibrahim MN, McClure EM, Ali AS, Tikmani SS, Reza S, Abbasi Z, Raza J, Yasmin H, Bano K, Zafar A, Siddiqi S, Goldenberg RL, Saleem S. Perceptions of parents and religious leaders regarding minimal invasive tissue sampling to identify the cause of death in stillbirths and neonates: results from a qualitative study. Reprod Health 2019; 16:53. [PMID: 31077244 PMCID: PMC6509850 DOI: 10.1186/s12978-019-0730-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background Recently, the minimal invasive tissue sampling (MITS) procedure has been developed to support determination of the cause of death as an alternate to conventional autopsy, especially in countries where complete diagnostic autopsy is not routine. To assess the feasibility of implementation of the MITS procedure for a study to determine cause of death in premature births and stillbirths in south Asia, we explored the views and perceptions of parents and religious leaders on the acceptability of MITS. Methods A qualitative study was conducted at the National Institute of Child Health (NICH) hospital of Karachi, Pakistan. Focus group discussions (FGDs) were conducted with parents of newborns who visited well-baby clinics of the NICH hospital for post-natal check-ups. Key-informant interviews (KIIs) were conducted with religious leaders. Data were analyzed using NVivo 10 software. Results A total of 13 interviews (FGDs = 8; KIIs = 5) were conducted. Three overarching themes were identified: (I) acceptability of MITS; (II) concerns affecting the implementation of MITS; and (III) religious and cultural perspectives. Participants’ acceptance of MITS was based on personal, religious, cultural and social beliefs. Parents widely recognized the need for this procedure in cases where the couple had experienced multiple stillbirths, neonatal deaths and miscarriages. Counseling of parents was considered vital to address emotional concerns of the parents and the family. Religious leaders indicated acceptability of the MITS procedure from a religious perspective and advised that respect for the deceased and consent of the guardians is mandatory when performing MITS. Conclusions This qualitative study provided a unique opportunity to understand the views of parents and religious leaders towards the use of MITS. Generally, MITS appears to be an acceptable method for identifying the cause of death in neonates and stillbirths, provided that the deceased is respected and buried as soon as possible without any delays and parents are counseled appropriately. Findings from this research are essential in approaching families for consent for MITS.
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Affiliation(s)
- Anam Feroz
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan.
| | | | | | - Anum Shiraz Ali
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Shiyam Sunder Tikmani
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Sayyeda Reza
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Zahid Abbasi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- Jinnah Post-graduate Medical Center, Department of Obstetrics and Gynecology-Department of Pathology and Laboratory Medicine, Karachi, Pakistan
| | - Khadija Bano
- Jinnah Post-graduate Medical Center, Department of Obstetrics and Gynecology-Department of Pathology and Laboratory Medicine, Karachi, Pakistan
| | - Afia Zafar
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | | | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
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Feroz A, Ibrahim MN, Tikmani SS, Reza S, Abbasi Z, Raza J, Yasmin H, Bano K, Zafar A, McClure EM, Goldenberg RL, Saleem S. Perceptions of parents and healthcare professionals regarding minimal invasive tissue sampling to identify the cause of death in stillbirths and neonates: a qualitative study protocol. Reprod Health 2018; 15:179. [PMID: 30348179 PMCID: PMC6198378 DOI: 10.1186/s12978-018-0626-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Globally, around 2.6 million neonatal deaths occur world-wide every year and the numbers of stillbirths is almost similar. Pakistan is ranked among the highest countries in the world for neonatal mortality. In 2016, for every 1000 babies born in Pakistan, 46 died before the end of the first month of life. Also, Pakistan had the highest rate of stillbirths (43.1/1000 births) in 2015. To meet sustainable development (SDG) targets of reducing neonatal mortality and stillbirths, it is essential to gain understanding about the causes of neonatal death and stillbirths. In Pakistan, full autopsies are conducted only in medico-legal cases and are very rarely performed to identify a definitive cause of death (CoD) and because of cost and insufficient staff are generally not feasible. Recently, minimally invasive tissue sampling (MITS) has been used to determine CoD in neonates and stillbirths as it addresses some of the socio-cultural and religious barriers to autopsy. However, it is not known how families and communities will perceive this procedure; therefore, exploring family and healthcare professionals’ perceptions regarding MITS is essential in determining acceptable and feasible approaches for Pakistan. Methods The study will employ an exploratory qualitative research design. The study will be conducted at the National Institute of Child Health (NICH) hospital of Karachi. The data collection method will consist of key-informant interviews (KIIs) and focus group discussions (FGDs). FGDs will be conducted with the families and relatives of newborns who are visiting the outpatient department (OPD) and well-baby clinics of NICH hospital. KIIs will be conducted with the NICH - medical director, healthcare providers, professionals involved in proceedings related to death and dying, religious leaders, health sector representatives from the government, public health experts, maternal and child health (MCH) specialists, obstetricians and neonatologists and experts from the bioethics committee. Study data will be analyzed using NVivo 10 software. Discussion The research will help explore specific cultural, religious and socio-behavioral factors that may increase or decrease the acceptability of MITS for identifying COD in neonates and stillbirths. The findings of the qualitative study will provide a better understanding of parents’ and healthcare professionals’ attitudes towards the use of MITS on neonatal deaths and stillborns.
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Affiliation(s)
- Anam Feroz
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | | | - Shiyam Sunder Tikmani
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Sayyeda Reza
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Zahid Abbasi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Khadija Bano
- Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Afia Zafar
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | | | | | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
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Bhutta SZ, Yasmin H. Comparative Effectiveness of Teaching Obstetrics and Gynaecological Procedural Skills on Patients versus Models: A randomized trial. Pak J Med Sci 2018; 34:794-798. [PMID: 30190730 PMCID: PMC6115552 DOI: 10.12669/pjms.344.15521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To compare the effectiveness of learning procedural skills on patients versus mannequins and models. Methods: Seventy four interns from two consecutive batches at the Department of Obstetrics and Gynaecolgy Unit-I at Jinnah Postgraduate Medical Center Karachi participated in the study between April and September 2014. Five basic skills; taking a cervical (Pap) smear, intrauterine contraceptive device insertion, manual vacuum aspiration, making/ suturing an episiotomy and active management of the third stage of labour were identified. Interns were randomly allocated to two training groups (Group-1 and 2 of thirty eight and thirty six trainees respectively), with Group-I received training on the five procedural skills on models and mannequins for four weeks while Group-II trained on patients initially. After an evaluation at four weeks the groups crossed over with a final evaluation at eight weeks. The evaluation was through identical objective structured assessment of technical skills on models and mannequins for both groups with standard checklists. Results: There was no significant difference in skills between the two groups at the four weeks assessment. However at the end of training, Group-1 trainees performed significantly better than Group 2 with higher overall tests scores (86.7 ± 2.7 versus 80.4 ± 4.8, p< 0.001). This difference was more marked in skills of intrauterine contraceptive device insertion, making and suturing an episiotomy and active management of third stage of labour. Conclusion: Our findings suggest that simulations using models and mannequins for developing procedural skills can be readily incorporated in training programs with potential benefits for teaching infrequently performed or more difficult procedures. Our data suggest potential benefits of initiation of trainings on simulations and mannequins followed by human subject exposure.
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Affiliation(s)
- Shereen Zulfiqar Bhutta
- Prof. Shereen Zulfiqar Bhutta, Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Haleema Yasmin
- Dr. Haleema Yasmin, Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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McClure EM, Saleem S, Goudar SS, Dhaded S, Guruprasad G, Kumar Y, Tikmani SS, Kadir M, Raza J, Yasmin H, Moore JL, Kim J, Bann C, Parlberg L, Aceituno A, Carlo WA, Silver RM, Lamberti L, Patterson J, Goldenberg RL. The project to understand and research preterm pregnancy outcomes and stillbirths in South Asia (PURPOSe): a protocol of a prospective, cohort study of causes of mortality among preterm births and stillbirths. Reprod Health 2018; 15:89. [PMID: 29945651 PMCID: PMC6020001 DOI: 10.1186/s12978-018-0528-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background In South Asia, where most stillbirths and neonatal deaths occur, much remains unknown about the causes of these deaths. About one-third of neonatal deaths are attributed to prematurity, yet the specific conditions which cause these deaths are often unclear as is the etiology of stillbirths. In low-resource settings, most women are not routinely tested for infections and autopsy is rare. Methods This prospective, cohort study will be conducted in hospitals in Davengere, India and Karachi, Pakistan. All women who deliver either a stillbirth or a preterm birth at one of the hospitals will be eligible for enrollment. With consent, the participant and, when applicable, her offspring, will be followed to 28-days post-delivery. A series of research tests will be conducted to determine infection and presence of other conditions which may contribute to the death. In addition, all routine clinical investigations will be documented. For both stillbirths and preterm neonates who die ≤ 28 days, with consent, a standard autopsy as well as minimally invasive tissue sampling will be conducted. Finally, an expert panel will review all available data for stillbirths and neonatal deaths to determine the primary and contributing causes of death using pre-specified guidance. Conclusion This will be among the first studies to prospectively obtain detailed information on causes of stillbirth and preterm neonatal death in low-resource settings in Asia. Determining the primary causes of death will be important to inform strategies most likely to reduce the high mortality rates in South Asia. Trial registration Clinicaltrials.gov (NCT03438110) Clinical Trial Registry of India (CTRI/2018/03/012281).
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Affiliation(s)
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, Karnataka, India
| | - Sangappa Dhaded
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, Karnataka, India
| | - G Guruprasad
- Bapuji Educational Association's J.J.M. Medical College, Davangere, Karnataka, India
| | - Yogesh Kumar
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, Karnataka, India
| | | | | | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | | | - Janet L Moore
- RTI International, 3040 Cornwallis Road, Durham, NC, 27709, USA
| | - Jean Kim
- RTI International, 3040 Cornwallis Road, Durham, NC, 27709, USA
| | - Carla Bann
- RTI International, 3040 Cornwallis Road, Durham, NC, 27709, USA
| | | | - Anna Aceituno
- RTI International, 3040 Cornwallis Road, Durham, NC, 27709, USA
| | | | - Robert M Silver
- University of Utah School of Medicine, Salt Lake City, UT, USA
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Yasmin H, Anbumalarmathi J, Sharmili SA. Phytochemical analysis and antimicrobial activity of garlic (Allium sativum L.) and onion (Allium cepa L.). ACTA ACUST UNITED AC 2018. [DOI: 10.5958/2348-7542.2018.00035.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Solomon E, Yasmin H, Duffy M, Malde S, Ockrim J, Greenwell T. Concordance of urodynamic definitions of female bladder outlet obstruction. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)31177-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hayat T, Nisar Z, Yasmin H, Alsaedi A. Peristaltic transport of nanofluid in a compliant wall channel with convective conditions and thermal radiation. J Mol Liq 2016. [DOI: 10.1016/j.molliq.2016.04.080] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Peristaltic flow of magnetohydrodynamic (MHD) Williamson fluid in a symmetric channel is addressed. Modeling is given with Soret and Dufour effects. Channel walls have compliant properties. Analysis has been carried out through long wavelength and low Reynolds number approach. The obtained series solutions for small Weissenberg number are developed. Impact of variables reflecting the salient features of wall properties, Biot numbers and Soret and Dufour on the velocity, temperature and concentration has been point out. Trapping phenomenon is also analyzed.
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Affiliation(s)
- T. Hayat
- Department of Mathematics, Quaid-I-Azam University 45320, Islamabad 44000, Pakistan
- Department of Mathematics, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Naheed Batool
- Department of Mathematics, Quaid-I-Azam University 45320, Islamabad 44000, Pakistan
| | - H. Yasmin
- Department of Mathematics, COMSATS Institute of Information Technology, G. T. Road, Wah Cantt 47040, Pakistan
| | - A. Alsaedi
- Department of Mathematics, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - M. Ayub
- Department of Mathematics, Quaid-I-Azam University 45320, Islamabad 44000, Pakistan
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Abstract
Mathematical model is developed for peristaltic flow of viscous fluid through a compliant wall channel subject to melting heat transfer. Fluid is incompressible and magnetohydrodynamic. Analysis has been performed in the presence of Joule heating and thermal radiation. Solutions for small wave number are obtained. Physical quantities of interest are examined for various parameters of interest.
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Affiliation(s)
- T. Hayat
- Department of Mathematics, Quaid-i-Azam University 45320, Islamabad 44000, Pakistan
| | - Maimona Rafiq
- Department of Mathematics, Quaid-i-Azam University 45320, Islamabad 44000, Pakistan
| | - B. Ahmad
- Department of Mathematics, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - H. Yasmin
- Department of Mathematics, COMSATS Institute of Information Technology, G. T. Road, Wah Cantt 47040, Pakistan
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Nahar L, Nahar K, Hossain MI, Yasmin H, Annur BM. Placental changes in pregnancy induced hypertension and its impacts on fetal outcome. Mymensingh Med J 2015; 24:9-17. [PMID: 25725662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A descriptive cross sectional study was carried out in the Gynae and Obstetrics & Pathology department of Mymensingh Medical College & Hospital (MMCH) to see the placental changes in normal & pregnancy induced hypertension (PIH) and its impacts on fetus for one year period. Total 80 placentas were collected, 40 from normal pregnant mothers having no hypertension and 40 from PIH group (one from gestational hypertension, 17 from pre-eclampsia and 22 from eclampsia. Macroscopic study of the placenta revealed placental weight, surface area and number of cotyledons were less in study group. Mean placental weight in study group was 419.50gm and in control group was 477.50 (p<0.001). Mean surface area in study group & control group were 232.29cm² and 304.80cm² respectively (p<0.001). Mean number of cotyledons were 15.39 and 17.40 in study & control group respectively (P<0.001) and lower diameter of umbilical cord (p<0.04667). But in the present study placental thickness was not significant (p<0.539). There was a single umbilical artery present in one patient in PIH group .In PIH group syncytial knots (95%), fibrinoid necrosis (80%), VSM (vasculosyncytial membrane) formation, sclerosis, chorangiosis and calcification were more marked. Infarction was present in placenta of PIH 34(85%) and in control group 8(20%). There was a tendency of lowering the weight of neonate 2.47kg in study group and 3.06kg in control group (p<0.001), number of asphyxiated babies and perinatal morbidity and mortality( still birth was 7.5 and neonatal death was 15%) were more marked in PIH group. In PIH group placental changes were related with fetal outcome. Common placental changes were significant in this study.
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Affiliation(s)
- L Nahar
- Dr Lutfun Nahar, Junior Consultant (Reg), Department of Gynae & Obst. Mymensingh Medical College Hospital, Mymensingh, Bangladesh
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Abstract
Magnetohydrodynamic peristaltic flow of Jeffery fluid in an asymmetric channel is addressed. The channel walls satisfy the convective conditions. Asymmetry here is considered due to wave trains of different amplitudes and phases. Solutions for the velocity, temperature and pressure gradient are obtained using long wavelength approximation. Plots reflecting the impact of various parameters of interest are shown and examined.
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Affiliation(s)
- M. Awais
- Department of Mathematics, COMSATS Institute of Information Technology, Attock, Pakistan
| | - S. Farooq
- Department of Mathematics, COMSATS Institute of Information Technology, Attock, Pakistan
| | - H. Yasmin
- Department of Mathematics, Quaid-I-Azam University 45320, Islamabad 44000, Pakistan
| | - T. Hayat
- Department of Mathematics, Quaid-I-Azam University 45320, Islamabad 44000, Pakistan
- Department of Mathematics, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - A. Alsaedi
- Department of Mathematics, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Zaidi S, Begum F, Tank J, Chaudhury P, Yasmin H, Dissanayake M. Achievements of the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences in South-Southeast Asia. Int J Gynaecol Obstet 2014; 126 Suppl 1:S20-3. [DOI: 10.1016/j.ijgo.2014.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zaidi S, Yasmin H, Hassan L, Khakwani M, Sami S, Abbas T. Replacement of dilation and curettage/evacuation by manual vacuum aspiration and medical abortion, and the introduction of postabortion contraception in Pakistan. Int J Gynaecol Obstet 2014; 126 Suppl 1:S40-4. [PMID: 24743026 DOI: 10.1016/j.ijgo.2014.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception was provided in 5 selected public hospitals in Pakistan. In the largest hospital, an Ipas MVA training center since 2007, MVA use reached 21% in 2008. After the International Federation of Gynecology and Obstetrics (FIGO) and UNFPA provided MVA kits, MVA use increased dramatically to 70%-90% in 2010-2013. In 2 of the remaining 4 hospitals in which the Society of Obstetricians and Gynecologists of Pakistan trained doctors in May 2012 and January 2013, the target of having 50% of women managed by MVA and medical abortion (MA) was met; however, in the third hospital only 43% were treated with MVA and MA. In the fourth hospital, where misoprostol and electric vacuum aspiration use was 64% and 9%, respectively, before training, an MVA workshop introduced the technique. Postabortion contraception was provided to 9%-29% of women, far below the target of 60%.
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Affiliation(s)
- Shahida Zaidi
- Ultrasound Clinic and Institute of Ultrasonography, Karachi, Pakistan.
| | | | | | | | - Shehla Sami
- Sandeman Provincial Hospital, Quetta, Pakistan
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Korejo R, Nasir A, Yasmin H, Bhutta S. Emergency obstetric hysterectomy. J PAK MED ASSOC 2012; 62:1322-1325. [PMID: 23866483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the frequency of obstetric hysterectomy, its indications and associated maternal and perinatal morbidity and mortality. METHODS The retrospective observational analytical study was conducted at the Department of Obstetrics and Gynaecology, Unit-I, Jinnah Postgraduate Medical Centre, Karachi from January 2003 to December 2009. Records of all patients who had underone hysterectomy at the study centre during the study period were explored for age, parity, booking status indication and the type of operation performed. Maternal and foetal morbidity and mortality were also recorded. SPSS 13.0 was used for statistical analysis. RESULTS Against the total 44,612 deliveries during the period, 121 hysterectomies were performed for obstetric indications. The frequency of the procedure, as such, was 1 in 368 (0.27%) deliveries. The major indications were ruptured uterus in 57 (47.1%), and severe postpartum haemorrhage due to atony of uterus in 35 (28.9%). Other indications included severe haemorrhage due to placental abnormalities in 14 (11.6%); placenta previa in 3 (2.5%); abruptio placenta in 4 (3.3%); and severe infection following vaginal delivery in 3 (2.5%). Infection was the commonest complication seen in 14 (11.6%) patients. There were 11 (9.0%) maternal deaths and 65 (53.7%) perinatal deaths. CONCLUSION Emergency obstetric hysterectomy remains a necessary tool for consultant obstetricians. Acting at the optimal time with clear judgment, and professional surgical technique can reduce morbidity and mortality in such cases.
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Affiliation(s)
- Razia Korejo
- Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi.
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Nasir A, Yasmin H, Korejo R. Management of iron deficiency anaemia in gynaecological patients at Jinnah Postgraduate Medical Centre, Karachi. J PAK MED ASSOC 2011; 61:998-1001. [PMID: 22356035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine the efficacy and safety of subcutaneously administered recombinant human erythropoietin in combination with intravenous iron sucrose for the management of iron deficiency anaemia in gynaecological patients in Jinnah Postgraduate Medical Centre Karachi. METHODS It was an interventional quasi experimental study carried out in the Department of Obstetrics /Gynaecology, at JPMC from 1st Nov 2007 to May 2008. All patients with indications for major Gynaecological surgery with iron deficiency anaemia having a mean haemoglobin level of 7 gm/dl were selected and the target haemoglobin was 11 gm/dl. Patients who were symptomatic, had chronic bleeding, renal failure or had signs of anaemia other than iron deficiency were excluded from the study. All investigations were done on day one before the start of therapy, and then treatment was initiated with recombinant human erythropoietin in a dose of 5000 IU subcutaneously and injection Iron Sucrose 200 mg in 100cc NaCI intravenously on 3 alternate days. The parameters checked in succession on day 4 and day 10 included increase in haemoglobin level, haematocrit, reticulocyte count, and time required to reach the target haemoglobin. RESULTS Twenty three patients fulfilled the inclusion criteria and were selected for the study. At the end of 10 days of starting therapy increase in haemoglobin was on an average of 2.8 gm/dl, increase in mean corpuscular volume was 4fl, Serum Iron increased by 99.86 ug%, total iron binding capacity decreased by 30.86%, transferrin saturation increased by 15.5% .There were no serious reactions to Erythropoietin or Iron sucrose CONCLUSION It is concluded that recombinant erythropoietin along with iron sucrose safely increased the haemoglobin level in 10 days to the target level thus rendering the patients fit for surgery and, none of the selected patients needed blood transfusion.
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Affiliation(s)
- Ayesha Nasir
- Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi
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Rehman A, Rehman T, Shaikh MA, Yasmin H, Asif A, Kafil H. Pakistani medical students' specialty preference and the influencing factors. J PAK MED ASSOC 2011; 61:713-718. [PMID: 22204259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To elucidate the specialty preferences of Pakistani medical students and the factors which influence medical students to make the decision regarding which specialty to pursue. METHODS Both basic sciences and clinical students from four medical colleges of Pakistan, i.e., Dow Medical College, Sindh Medical College, Liaquat National Medical College and Muhammad Medical College, were included in the cross-sectional survey during the period of July 2008 to Jan' 2009. After ethical acceptance, data was collected using convenient sampling technique. The questionnaire covered the following demographic details: 13 common specialties and 15 influencing factors. RESULTS Questionnaires included in the analysis were 771. Most students gave preference to surgery and its associated sub-specialties (50.3%) followed by internal medicine (26.8%), paediatrics (23.2%), dermatology (16.7%), gynaecology and obstetrics (16.7%), psychiatry (13.1%), radiology (10.8%), ENT (8.8%), anaesthesiology (8.7%), administrative medicine (8.6%), orthopaedics (8.2%), ophthalmology (7.5%), and laboratory medicine (6.1%). The highly considered factors (regarding specialties) chosen by 70% of the medical students were: applicable to respective personalities of the individuals, prestige and respect, international opportunities, and time commitment. Surgical-skills, job availability, financial rating, academic performance, and a role model were moderately influencing factors. Hospital environment, parents, general practice, peer-pressure and personal health were the least influential. CONCLUSION This trend suggests competition in surgery and its sub-specialties along with internal medicine, paediatrics, dermatology, gynaecology and obstetrics. Specialty suited to personality, time commitment, prestige/respect and international opportunity, influenced more than 70% of the students.
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Memon S, Kumari K, Yasmin H, Bhutta S. Is it possible to reduce rates of placenta praevia? J PAK MED ASSOC 2010; 60:566-569. [PMID: 20578609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine factors responsible for rising rates of placenta praevia. METHODS This comparative study was performed at Jinnah Post Graduate Medical Centre Karachi, (Group-A) from September 2000 to February 2002 and (Group-B) from January 2008 to January 2009. All women with major degree of placenta praevia diagnosed on ultrasound who came in emergency or through out patient department were included in the study. Patients with mild degree of placenta praevia were excluded. Group A had 100 patients and Group B, 58 patients. Chi-Squire test was used for comparison of previous study and current study. RESULTS The number of unbooked cases in both groups A and B was high (A=76%, B=62%). Most patients were grandmultipara (A=41%, B=34%) with ages ranging from 31-35 years (A=36%, B=43%). Even primigravida had a major degree of placenta praevia (A=17%, B=7%). There was a significant difference in two groups in term of previous caesarean section (A=12%, B=38%). Association of placenta praevia following miscarriages was also noted (A=41%, B=29%). Placenta accrete were noted in two cases in group B, both required obstetrical hysterectomies. The results revealed a favourable foetal out come in both groups, A= 93 (93%), B=55 (95%). CONCLUSION With rising rate of previous caesarean sections over an eight year period from 12% to 38% the frequency of placenta praevia has increased. Most patients continue to present as unbooked cases in emergency, there fore the associated morbidity due to haemorrhage remains high. Therefore efforts should be made to avoid primary caesarean section where possible. In addition antenatal care and timely diagnosis of placenta praevia on ultrasound can decrease the associated morbidity.
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Chakravart A, Chatterjee S, Yasmin H, Mazumder T. Comparison of Efficacy of Turmeric and Commercial Curcumin in Immunological Functions and Gene Regulation. INT J PHARMACOL 2009. [DOI: 10.3923/ijp.2009.333.345] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yasmin H. O1025 Efficacy and safety of MVA (manual vacuum aspirator) in the treatment of incomplete and missed abortion. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Women with a history of infertility are associated with a higher incidence of adverse pregnancy outcome. This retrospective study reviewed 105 women with a known history of infertility; of these 105 women, 77 (73%) conceived spontaneously and 28 (27%) had assisted conception. Our finding confirms higher perinatal complications; relative ratios (RR) for pre-eclampsia was 4.6 (95% CI=2.1-9.9), intrauterine growth restriction 4.8 (95% CI=1.9-12.0), gestational diabetes 1.8 (95% CI=0.5-5.8), pre-term premature rupture of membrane 2.3 (95% CI=0.6-8.8) and pre-term labour 2.6 (95% CI=1.1-5.9). We postulate that women with a history of infertility are at high risk of such obstetric complications and may benefit from intensified antenatal care.
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Affiliation(s)
- H Yasmin
- Department of Obstetrics and Gynaecology, Stafford General Hospital, Stafford, UK.
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Affiliation(s)
- H Yasmin
- Department of Obstetrics and Gynaecology, New Cross Hospital NHS Trust, Wolverhampton, UK.
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Affiliation(s)
- D Sinha
- Department of Obstetrics & Gynaecology, New Cross Hospital NHS Trust, Wolverhampton, UK.
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Yasmin H, Nasir A, Noorani KJ. Hystroscopic management of Ashermans syndrome. J PAK MED ASSOC 2007; 57:553-555. [PMID: 18062521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To confirm the diagnosis of Asherman's syndrome in patients with scanty menses/amenorrhoea or infertility and to assess the effectiveness of hysteroscopy in the treatment of Asherman's syndrome. METHODS A hospital based descriptive study conducted on 20 patients presenting with amenorrhoea, oligomenorrhoea, or infertility from Jan 2004 to June 2005. They were selected after excluding hormonal imbalances, premature ovarian failure and congenital uterine abnormalities. All patients underwent diagnostic hysteroscopy and resection of adhesions. Specimens were sent for Histopathology and bacterial culture. RESULT A total of 20 patients were included in this study, the median age was 26 years, 65% had presented with scanty menses with secondary infertility, 20% with secondary ammenorrhoea, and 15% with primary infertility alone. Hysteroscopic findings showed thick fibrous adhesions in 45% patients, 40% had flimsy adhesions and 15% had muscular adhesions. It was seen that 65% had adhesions in the body of uterus, 25% at the site of internal os and 1% had adhesions in the cervical canal as well as the body of the uterus. Normal menstrual cycle was resumed in 95% patients, whereas two patients conceived and were followed to term. Dense fibrous tissue with few patches of calcification and no signs of secretory or proliferative cells was found in 35% patients. In 45% endometrium showed proliferative changes and collagen fibers. Only 1 patient had a positive AFB culture and the histopathology showed few graulomas with epitheloid cells most of the tissue replaced by necrotic tissue with patchy areas of caseation. CONCLUSION Hysteroscopy is an effective procedure for not only diagnosing Ashermans Syndrome, but is equally effective for treating it..
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Affiliation(s)
- Haleema Yasmin
- Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi
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Abstract
Chronic pelvic pain remains unexplained in one third of women who have negative [normal] findings at diagnostic laparoscopy. This paper investigates the history of chronic pelvic pain after a negative laparoscopy and to assess the effect of negative laparoscopy on self perceived quality of life. The results of this study show that chronic pelvic pain persists in the majority of women who had negative laparoscopy in the medium to long term. It also shows that laparoscopy is beneficial in such group of women when findings are negative, due to its reassuring effect. A few quality of life issues also seem to improve despite persistence of chronic pelvic pain after a negative [normal] laparoscopy.
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Affiliation(s)
- H Yasmin
- Department of Obstetrics & Gynaecology, Queens Hospital NHS Trust, Burton on Trent, UK.
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Zahoor S, Hussain M, Yasmin H, Noorani KJ. Heterotopic pregnancy-outcome and management. J Coll Physicians Surg Pak 2004; 14:494-5. [PMID: 15321043 DOI: 08.2004/jcpsp.494495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/15/2003] [Accepted: 06/23/2004] [Indexed: 11/03/2022]
Abstract
A case of heterotopic pregnancy is reported that presented with 7 weeks of amenorrhea, lower abdominal pain and spotting per vaginum. Ultrasound showed an intra-uterine gestational sac as well as right-sided ruptured tubal pregnancy. Emergency laparotomy and right salpingectomy was performed. Subsequent ongoing alive intra-uterine pregnancy was delivered by vaginal route at term.
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Affiliation(s)
- Shaheena Zahoor
- Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi
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Hussain M, Ashraf M, Yasmin H, Sattar TA, Rafique M, Bhutta SZ. Pelvic spleen with uterovaginal prolapse. J Coll Physicians Surg Pak 2004; 14:496-8. [PMID: 15321044 DOI: 08.2004/jcpsp.496498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Accepted: 05/28/2004] [Indexed: 11/03/2022]
Abstract
A case of wandering (pelvic) spleen associated with third degree uterovaginal prolapse and ascaris in the biliary and intestinal tract is being presented here. On laparotomy; congested splenomegaly was found in the pelvis. Splenectomy, total abdominal hysterectomy and bilateral salpingo-ophrectomy was performed.
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Affiliation(s)
- Munawar Hussain
- Department of Obstetrics/Gynaecology, Jinnah Postgraduate Medical Centre, Karachi.
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