Implementation of Basel II in Microfinance Sector of Pakistan

The Basel, the new accord on banking regulation and supervision covers the risk of capital and credit risk. Basel II covers the additional risk of market which completes the first and second pillars. It includes the disclosure of basic information to its market participants. This information is a sum of risks that institution has to face, capital risk exposure, risk assessment process, capital adequacy of the bank, the techniques to account fall the risks. The aim of the study was to implement Basel II in microfinance sector of Pakistan. The study is unique because it is never analyzed before in microfinance sector of Pakistan. The discussion method was used for results and results of the study shows that new accord will definitely help the managers and practitioners to evaluate the performance of this sector. Keywords: Basel 1, Basel II, Capital Accord, Microfinance, CAR, Operational Risk, Market Risk

Pain and anxiety management for pediatric dental procedures using various combinations of sedative drugs: A review

AbstractFor fearful and uncooperative children behavioral management techniques are used. In order to control the pain and anxiety in pedodontic patients, pharmacologic sedation, anesthesia and analgesia are commonly used. Midazolam is commonly used as an oral sedation agent in children; it has several features such as safety of use, quick onset and certain degree of amnesia that makes it a desirable sedation agent in children. This review paper discusses various aspects of oral midazolam, ketamine and their combinations in conscious sedation including, advantages of oral route of sedation, pharmacokinetics, range of oral doses, and antagonists for clinical dental treatment procedures

Frequency of Lingual Nerve Injury after the Removal of Impacted Mandibular Third Molar

Objective: to determine the frequency of lingual nerve injury after the removal of impacted mandibular 3rd molar. Study Design: Cross sectional study Place and duration: outdoor patient department of Oral and Maxillofacial Surgery Hitec Dental College, Foundation College of Dentistry Peace Gernal Hospital, Nishtar Institute of  Dentistry,Multan from January 2018 to January 2019 in one year duration. Results: Study included 335 patients with mean age of 20.86+ 1.95 yrs. Males were 190(56.7%) and females were 145(43.3%).lingual nerve injury was found in 28 patients(8.4%)while it was absent in 307 patients(91.6%).There was no significant effect was found on the frequency of lingual nerve injury for age or gender of the patient population. Conclusion: Lingual nerve injury is a commonly encountered complication among those undergoing extraction of impacted third molar. It should be carefully sought in all the patients undergoing the surgical procedure and improvement in surgical skills and techniques needs to be emphasized to further reduce the incidence and risk of this complication. Keywords: Impacted third molar, Lingual nerve, OPG (orthopantomogram), Dentistry, Mandible. DOI: 10.7176/JMPB/57-01 Publication date: July 31st 201

Frequency of Mandibular 3rd Molar Presence and Position on Risk of Mandibular Angle Fracture

Objective of study was to determine the frequency of mandibular third molar presence and position in mandibular angle fractures. Study Design: Cross Sectional Study Setting: This study was carried out in department of dentistry, Nishtar institute of dentistry, Multan. Duration of Study: This study was conducted from 1st July 2016 to 31st January 2017. Methadology: Study was started after taking informed  consent from the patients and approval of ethical committee. Fracture side was diagnosed by history and examination. Status of mandibular third molar (erupted, un-erupted and impacted) on the side of fracture was evaluated through clinical and radio-graphical examination. Data was collected for basic demographics (Age, Sex and side of fracture).Patients from both gender with age range of 25-40 years having mandibular angle fracture of any side of < one month duration were included in this study. Patients with history of extraction of mandibular third molar and those with history of fracture from gunshot injury were excluded from the study.Data was collected for mandibular third molar presence and position and noted in especially designed proforma. Results: A total of 158 patients of both gender with mandibular angle fracture of any side were included. Age range in this study was from 25 to 40 years with mean age of 32.689 ± 3.28 years, mean height 1.612 ± 0.04 meters, mean BMI 23.929 ± 2.08 Kg/m2 and mean duration of fracture was 11.354 ± 6.08 days. Majority of the patients (55.7%) belongs to 25-33 years age groups. While males were 90.5% as compare to females 9.5%. UnErupted Mandibular third molar  was seen in 12.7% patients, Erupted 44.3% and Impacted was 43%. Conclusion: Conclusion of this study is that the absence of an impacted third molar decrease the prevalence of mandibular angle fractures. Keywords: Mandibular angle fractures, Mandibular third molar, Frequency. DOI: 10.7176/JMPB/60-07 Publication date:October 31st 201

Diagnostic Accuracy of 3d Scan and Plain Radiograph in Diagnosis of Midface Fractures

OBJECTIVE: To determine the diagnostic accuracy of plain radiographs and 3D scan in diagnosis of mid face fractures by taking surgery findings as a gold standard. STUDY DESIGN: Cross Sectional Study SETTING: study was carried out at  Department of Oral & Maxillofacial Surgery, Nishtar Institute of Dentistry, Multan. DURATION: Study was completed in 6 months from May, 2017 to  November 2017in Nishtar . Methodology: 181 Patients were included  from Department of Oral & Maxillofacial Surgery, Nishtar Institute of Dentistry, Multan after taking informed consent and permission from ethical committee and research department. Demographic information of patients (name, age, gender, duration of  Fracture had taken. Patients from both gender with age range of 18-35 years having Maxillofacial trauma < 10 days were included in this study and patients in which CT scan was contraindicated and those taken any surgical treatment for facial trauma were excluded in this study. Radiographic examination for the cranio-facial complex had performed for all patients followed by routinely and according to the needs of each  individual case. RESULTS: From 181 patients, the minimum age was 18 years and maximum age was 35 years. According to plain radiographs, fracture was detected in  88.4% patients. By using 3D scan, fracture was detected in 96.7% patients. Sensitivity of 3D scan for detection of fracture was calculated as 98.13%, specificity was 14.28%, positive predicted value was 89.71%, negative predicted value was 50% and diagnostic accuracy was 88.39%. CONCLUSION: Among 181 patients, fracture was detected in 88.4% patients by using plain radiographs. By using 3D scan, fracture was detected in 96.7% patients. Sensitivity of 3D scan for detection of fracture was calculated as 98.13%, specificity was 14.28%, positive predicted value was 89.71%, and diagnostic accuracy was 88.39%. Keywords: 3D scan, plain radiographs, mid face fractures DOI: 10.7176/JMPB/60-01 Publication date:October 31st 2019

Clinical and Radiographic Features of Ameloblastoma: Ultimate Diagnosis and Treatment

Objectives: The purpose of this study was to compare the clinical and radiographic features of 22 intraosseous ameloblastomas. Study design: All the data with respect to the patient’s age, sex, tumor locations, surgical treatment history, as well as radiographic findings and number of recurrence, were analyzed. Results: The patient’s age at biopsy ranged from 08 to 70 years (mean, 31.5 years), Fourteen (63.6%) of the 22 subjects were females, and eight (36.4%) were males. Nineteen (86.4%) of the 22 ameloblastomas were located in mandible and three (13.6%) were located in maxilla. Pain, swelling and purulent discharge were the most common symptoms and were experienced by eight (36.4%) patients. Radiographically, seventeen (77.3%) of the 22 tumors were multilocular. Remaining five cases were unilocular with a well-demarcated border. There was no case exhibiting the typical soap-bubble appearance. The most common histologic pattern was plexiform and had follicular type. Conclusion: Diagnosis of ameloblastoma remained in doubt after clinical and radiographic examination. A biopsy is necessary for the confirmation of diagnosis. Surgical treatment should be planned after C.T and 3D Scan. Long-term follow-up at regular intervals after surgery is also recommended. Keywords: Ameloblastoma, Diagnosis, Radiographic DOI: 10.7176/JMPB/60-02 Publication date:October 31st 201

Clinical training alone is not sufficient for reducing barriers to IUD provision among private providers in Pakistan

<p>Abstract</p> <p>Background</p> <p>IUD uptake remains low in Pakistan, in spite of three major efforts to introduce the IUD since the 1960s, the most recent of these being through the private sector. This study examines barriers to IUD recommendation and provision among private providers in Pakistan.</p> <p>Methods</p> <p>A facility-based survey was conducted among randomly selected private providers who were members of the Greenstar network and among similar providers located within 2 Kilometers. In total, 566 providers were interviewed in 54 districts of Pakistan.</p> <p>Logistic regression analysis was conducted to determine whether correct knowledge regarding the IUD, self-confidence in being able to insert the IUD, attitudes towards suitability of candidates for the IUD and medical safety concerns were influenced by provider type (physician vs. Lady Health Visitor), whether the provider had received clinical training in IUD insertion in the last three years, membership of the Greenstar network and experience in IUD insertion. OLS regression was used to identify predictors of provider productivity (measured by IUD insertions conducted in the month before the survey).</p> <p>Results</p> <p>Private providers consider women with children and in their peak reproductive years to be ideal candidates for the IUD. Women below age 19, above age 40 and nulliparous women are not considered suitable IUD candidates. Provider concerns about medical safety, side-effects and client satisfaction associated with the IUD are substantial. Providers' experience in terms of the number of IUDs inserted in their careers, appears to improve knowledge, self-confidence in the ability provide the IUD and to lower age-related attitudinal barriers towards IUD recommendation. Physicians have greater medical safety concerns about the IUD than Lady Health Visitors. Clinical training does not have a consistent positive effect on lowering barriers to IUD recommendation. Membership of the Greenstar network also has little effect on lowering these barriers. Providers' barriers to IUD recommendation significantly lower their monthly IUD insertions.</p> <p>Conclusions</p> <p>Technical training interventions do not reduce providers' attitudinal barriers towards IUD provision. Formative research is needed to better understand reasons for the high levels of provider barriers to IUD provision. "Non-training" interventions should be designed to lower these barriers.</p

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill &amp; Melinda Gates Foundation

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2\ub75th percentile and 100 as the 97\ub75th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59\ub74 (IQR 35\ub74–67\ub73), ranging from a low of 11\ub76 (95% uncertainty interval 9\ub76–14\ub70) to a high of 84\ub79 (83\ub71–86\ub77). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030