Gender Determination in Pakhtun Pakistani Population Using Dental Arch Dimensions: A Digital Model Study

@#Introduction: In circumstances where the ante mortem list is unknown, gender determination would exclude onehalf of the population, aid in a more precise search of the ante mortem records. This study aims to formulate gender prediction models in the Pakhtun Pakistani population using digital dental arch dimensions. Methods: Data collection and analysis of the dental casts were conducted on 128 subjects, 64 males and 64 females from the Pakistani population. The mean age of the subjects was 19.2 years old. Several linear dental arch dimensions were measured and recorded for both upper and lower arches. Results: It was found that gender differences in linear arch dimensions were statistically significant for both males and females (p<0.05); in which the arch dimensions for the males were larger than the arch dimensions for the females. Stepwise discriminant function analysis found that the highest discriminant power of the variables was present within the inter-second premolar width for the upper arch and inter-molar width for the lower arch. These variables significantly contributed to gender variance. Moreover, the prediction of 67.2% of original grouped cases for the upper arch and 66.4% of cross-validated group cases was correct. Similarly, the correct prediction was made on 64.8% of original grouped cases for the lower arch and 64.1% of cross-validated group cases. Conclusion: The dental arch dimensions were larger among the males compared to the females. Prediction models obtained in this study were moderately strong predictors which may be used as an adjunct to predict gender.

Effectiveness of management of severe acute malnutrition (SAM) through community health workers as compared to a traditional facility-based model: a cluster randomized controlled trial.

PURPOSE: We compared the impact of management of severe acute malnutrition (SAM) by lady health workers (LHWs) at a community level with the standard CMAM program provided at the health facility. METHODS: A two-arm cluster randomised controlled trial was conducted in a rural district in sindh Pakistan. The primary outcome was recovery from SAM and secondary outcomes were relapse, defaulter and mortality rate. RESULTS: A total of 829 children were recruited in the trial (430 in intervention and 399 in control groups). No significant difference was noted in recovery rate between the intervention and control groups (79.2% vs 85.6%, p = 0.276). Similarly, no significant differences were noted in relapse (p = 0.757), weight gain (p = 0.609), deaths (p = 0.775) and defaulter rate (p = 0.324) across the groups. Compliance of RUTF was significantly higher in the control group (93%) than in the intervention group (87%), p < 0.000. CONCLUSION: Our results showed no impact of SAM treatment on performance indicators of CMAM (recovery, relapse, death and default) between the standard CMAM programme performed at the health facility by the government and NGO staff and the programme performed at health house level by the LHWs in Pakistan. We recommend further robust trials in other settings to confirm our results.

Evaluation of the cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by lady health workers as compared to an outpatient therapeutic feeding programme in Sindh Province, Pakistan.

BACKGROUND: Due to the limited evidence of the cost-effectiveness of Community Health Workers (CHW) delivering treatment for severe acute malnutrition (SAM), there is a need to better understand the costs incurred by both implementing institutions and beneficiary households. This study assessed the costs and cost-effectiveness of treatment for cases of SAM without complications delivered by government-employed Lady Health Workers (LHWs) and complemented with non-governmental organisation (NGO) delivered outpatient facility-based care compared with NGO delivered outpatient facility-based care only alongside a two-arm randomised controlled trial conducted in Sindh Province, Pakistan. METHODS: An activity-based cost model was used, employing a societal perspective to include costs incurred by beneficiaries and the wider community. Costs were estimated through accounting records, interviews and informal group discussions. Cost-effectiveness was assessed for each arm relative to no intervention, and incrementally between the two interventions, providing information on both absolute and relative costs and effects. RESULTS: The cost per child recovered in outpatient facility-based care was similar to LHW-delivered care, at 363 USD and 382 USD respectively. An additional 146 USD was spent per additional child recovered by outpatient facilities compared to LHWs. Results of sensitivity analyses indicated considerable uncertainty in which strategy was most cost-effective due to small differences in cost and recovery rates between arms. The cost to the beneficiary household of outpatient facility-based care was double that of LHW-delivered care. CONCLUSIONS: Outpatient facility-based care was found to be slightly more cost-effective compared to LHW-delivered care, despite the potential for cost-effectiveness of CHWs managing SAM being demonstrated in other settings. The similarity of cost-effectiveness outcomes between the two models resulted in uncertainty as to which strategy was the most cost-effective. Similarity of costs and effectiveness between models suggests that whether it is appropriate to engage LHWs in substituting or complementing outpatient facilities may depend on population needs, including coverage and accessibility of existing services, rather than be purely a consideration of cost. Future research should assess the cost-effectiveness of LHW-delivered care when delivered solely by the government. TRIAL REGISTRATION: NCT03043352 , ClinicalTrials.gov. Retrospectively registered.

Point-of-use water treatment improves recovery rates among children with severe acute malnutrition in Pakistan: results from a site-randomized trial.

OBJECTIVE: To evaluate effectiveness of point-of-use water treatment in improving treatment of children affected by severe acute malnutrition (SAM). DESIGN: Programme sites were randomized to one of four intervention arms: (i) standard SAM treatment; (ii) SAM treatment plus flocculent/disinfectant water treatment; (iii) SAM treatment plus chlorine disinfectant; or (iv) SAM treatment plus ceramic water filter. Outcome measures were calculated based on participant status upon exit or after 120d of enrolment, whichever came first. Child anthropometric data were collected during weekly monitoring at programme sites. Child caregivers were interviewed at enrolment and exit. Use of water treatment products was assessed in a home visit 4-6 weeks after enrolment. SETTING: Dadu District, Sindh Province, Pakistan. SUBJECTS: Children (n 901) aged 6-59 months with SAM and no medical complications. RESULTS: Recovery rates were 16·7-22·2 % higher among children receiving water treatment compared with the control group. The adjusted odds of recovery were approximately twice as high for those receiving water treatment compared with controls. Mean length of stay until recovery was 73 (sd 24·6) d and mean rate of weight gain was 4·7 (sd 3·0) g/kg per d. Differences in recovery rate, length of stay and rate of weight gain between intervention groups were not statistically significant. CONCLUSIONS: Incorporating point-of-use water treatment into outpatient treatment programmes for children with SAM increased nutritional recovery rates. No significant differences in recovery rates were observed between the different intervention groups, indicating that different water treatment approaches were equally effective in improving recovery.

Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan.

OBJECTIVE: To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. DESIGN: Cross-sectional quality-of-care study. SETTING: The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. SUBJECTS: LHW implementing treatment for uncomplicated SAM in the community. RESULTS: Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %. CONCLUSIONS: This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.

Association between genetic polymorphisms and external apical root resorption: A systematic review and meta-analysis / 대한치과교정학회지

OBJECTIVE: To date, only a few studies have investigated the relationships between genetic polymorphisms and external apical root resorption (EARR). Hence, the aim of this systematic review was to explore the relationship between different gene polymorphisms and their association with EARR. METHODS: A complete literature search was conducted by two independent reviewers. The PubMed, Science Direct, and Scopus databases were searched. In addition, the bibliographies of all textbooks and relevant articles were searched manually. A meta-analysis was performed using data entered into the electronic databases until February 28, 2017. RESULTS: On the basis of the search, we identified 17 and 7 publications for the systematic review and meta-analysis, respectively. Odds ratio (OR) was used to evaluate the association of the interleukin 1B (+3954) polymorphism and the risk of EARR. The overall OR from the studies was used to estimate the risk of EARR. However, no association was found and no publication bias was apparent for the risk of EARR in patients receiving orthodontic treatment. CONCLUSIONS: More research on the relationship between gene polymorphism and EARR is necessary to determine better specificity of possible interactions.

New prediction equations for the estimation of maxillary mandibular canine and premolar widths from mandibular incisors and mandibular first permanent molar widths: A digital model study / 대한치과교정학회지

OBJECTIVE: The primary aim of the study was to generate new prediction equations for the estimation of maxillary and mandibular canine and premolar widths based on mandibular incisors and first permanent molar widths. METHODS: A total of 2,340 calculations (768 based on the sum of mandibular incisor and first permanent molar widths, and 1,572 based on the maxillary and mandibular canine and premolar widths) were performed, and a digital stereomicroscope was used to derive the the digital models and measurements. Mesiodistal widths of maxillary and mandibular teeth were measured via scanned digital models. RESULTS: There was a strong positive correlation between the estimation of maxillary (r = 0.85994, r2 = 0.7395) and mandibular (r = 0.8708, r2 = 0.7582) canine and premolar widths. The intraclass correlation coefficients were statistically significant, and the coefficients were in the strong correlation range, with an average of 0.9. Linear regression analysis was used to establish prediction equations. Prediction equations were developed to estimate maxillary arches based on Y = 15.746 + 0.602 × sum of mandibular incisors and mandibular first permanent molar widths (sum of mandibular incisors [SMI] + molars), Y = 18.224 + 0.540 × (SMI + molars), and Y = 16.186 + 0.586 × (SMI + molars) for both genders, and to estimate mandibular arches the parameters used were Y = 16.391 + 0.564 × (SMI + molars), Y = 14.444 + 0.609 × (SMI + molars), and Y = 19.915 + 0.481 × (SMI + molars). CONCLUSIONS: These formulas will be helpful for orthodontic diagnosis and clinical treatment planning during the mixed dentition stage.