Association between hypodontia and angles malocclusion

Abstract This study was planned to determine the prevalence of hypodontia in permanent dentition and to test whether an association was present between hypodontia and Angle\u27s malocclusion. The retrospective study was conducted at a tertiary care hospital, Karachi, and comprised record of all patients visiting the orthodontic clinics of the hospital from 2005 to 2015. Orthodontic records of 790(79%) subjects, including 189(23.9%) males and 601(76.1%) females, were reviewed. Their mean age was 17 ± 5.06 years. A tooth was considered missing if no evidence of tooth germ was observed on orthopantomograms and dental casts. The total sample was distributed into three groups on the basis of Angle\u27s classification. Chi-square test was applied to determine an association between hypodontia and Angle\u27s malocclusion. Tooth agenesis was observed in 34(4.3%) and a statistically significant difference was found between the genders (p=0.005). A positive association was found between hypodontia and malocclusion groups. Higher frequency of missing teeth was seen in Class III malocclusion which indicates a great need for orthodontic treatment as it has a psychosocial impact on the quality of life

Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in developing countries

Background:Vitamin A deficiency is a major public health problem in developing countries. Vitamin A supplementation in children greater than six months of age has been found to be beneficial, with no effect of supplementation between one to five months. Supplementation in the neonatal period has been suggested to have an impact by increasing body stores in early infancy.Objectives: To evaluate the role of vitamin A supplementation in term neonates in developing countries with respect to the prevention of mortality and morbidity.Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, May 2010), EMBASE and MEDLINE (1966 to May 2010) via PubMed.Selection criteria: Randomised and quasi-randomised controlled trials. Trials with factorial designs were also included.Data collection and analysis: Two review authors independently assessed trial quality and extracted the data.Main results: Seven trials (51,446 neonates) were included in this review, with only few trials reporting disaggregated data for term infants. Therefore, we analysed data and presented estimates for term infants (where specified) followed by all infants. Data for term neonates from three studies showed a statistically significant effect on the risk of infant mortality at six months in the vitamin A group compared with the control group (typical risk ratio (RR) 0.82, 95% CI 0.68 to 0.99, I(2) 63%). Analysis of data for all infants from five studies showed a 14% reduction in the risk of infant mortality at six months in neonates supplemented with vitamin A compared to control, this reduction was statistically significant (typical RR 0.86, 95% CI 0.77 to 0.97, I(2) 39%). These findings should be interpreted with caution, however, due to the small number of included studies, wide confidence intervals with upper levels close to the null effect and statistical heterogeneity. Vitamin A supplementation failed to show any significant effect on infant mortality at 12 months of age compared to control (typical rate ratio 1.03, 95% CI 0.87 to 1.23, I(2) 49%). Limited data were available for the outcomes of cause-specific mortality and morbidity, vitamin A deficiency, anaemia and adverse events.Authors\u27 Conclusion: Considering mortality in early infancy being a major contributory cause of overall child mortality for the under five year old group in developing countries, it is critical to obtain sound scientific evidence of the effect of vitamin A supplementation in neonates. Evidence provided in this review does indicate a potential beneficial effect of supplementing neonates with vitamin A at birth for reducing mortality in the first half of infancy. Considering the absence of a clear indication of the biological mechanism and conflicting findings from individual studies in settings with varying levels of maternal vitamin A deficiency and infant mortality, and given four additional ongoing trials with approximately 100,000 neonates being enrolled, we propose a delay in any policy recommendations for neonatal vitamin A supplementation

Effect of Clark’s twin-block appliance (CTB) and non-extraction fixed mechano-therapy on the pharyngeal dimensions of growing children

Abstract INTRODUCTION: Narrow airway dimensions due to mandibular deficiency can predispose an individual to severe respiratory distress. Hence, treatment with mandibular advancement devices at an early age might help improving the pharyngeal passage and reduce the risk of respiratory difficulties. Therefore, the aim of the current study was to evaluate the mean changes in the pharyngeal dimensions of children with mandibular deficiency treated with Clark\u27s twin-block appliance (CTB) followed by fixed orthodontic treatment. METHODS: Orthodontic records of 42 children with mandibular deficiency were selected. Records comprised three lateral cephalograms taken at the start of CTB treatment, after CTB removal and at the end of fixed appliance treatment, and were compared with 32 controls from the Bolton-Brush study. Friedman test was used to compare pre-treatment, mid-treatment and post-treatment pharyngeal dimensions. Wilcoxon signed rank test was used to compare the airway between pre-treatment and post follow-up controls. Mann-Whitney U test was applied to compare the mean changes in pharyngeal dimensions between treatment group and controls from T2 to T0. Post-hoc Dunnet T3 test was used for multiple comparisons of treatment outcomes after CTB and fixed appliances, taking a p-value of ≤ 0.05 as statistically significant. RESULTS: Superior pharyngeal space (p \u3c 0.001) and upper airway thickness (p = 0.035) were significantly increased after CTB, and the change in superior pharyngeal space remained stable after fixed mechano-therapy. CONCLUSION: CTB can have a positive effect in improving pharyngeal space and the resultant increase in airway remains stable on an average of two and a half years

Daily contact with a patient and poor housing affordability as determinants of pulmonary tuberculosis in urban Pakistan

Objective: This study aimed to evaluate the factors associated with pulmonary tuberculosis (TB) among individuals aged 15years or more in urban Karachi, Pakistan.DESIGN AND SETTING: A case-control design was implemented in three major tertiary-care hospitals to select cases (n=342) with active pulmonary TB (i.e. two sputum smears positive for Mycobacterium tuberculosis with clinical and radiographic evidence of current pulmonary TB and diagnosed between August 2002 and October 2003. Selected controls (n=342) were surgery patients from the same hospitals at time of recruitment of the cases, without clinical and radiographic evidence of pulmonary TB.Results: Multivariable logistic regression model showed that daily contact with a pulmonary TB patient (adjusted odds ratio [ORadj])=5.07; 95% CI: 3.31, 7.78), and poor housing affordability (i.e. rented vs. owned) (ORadj=1.59; 95% CI: 1.13, 2.26) were significantly associated with pulmonary TB status. The overall adjusted summary population attributable risk (%) for both the risk factors together was 38.7.CONCLUSION: Reaching out to underprivileged TB patients for delivery of DOTS and focused education of patients and their contacts about M. tuberculosis transmission mode may substantially minimize pulmonary TB risk in this and similar settings

Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes

<p>Abstract</p> <p>Objectives/background</p> <p>Given the widespread prevalence of micronutrient deficiencies in developing countries, supplementation with multiple micronutrients rather than iron-folate alone, could be of potential benefit to the mother and the fetus. These benefits could relate to prevention of maternal complications and reduction in other adverse pregnancy outcomes such as small-for-gestational age (SGA) births, low birth weight, stillbirths, perinatal and neonatal mortality. This review evaluates the evidence of the impact of multiple micronutrient supplements during pregnancy, in comparison with standard iron-folate supplements, on specific maternal and pregnancy outcomes of relevance to the Lives Saved Tool (LiST).</p> <p>Data sources/review methods</p> <p>A systematic review of randomized controlled trials was conducted. Search engines used were PubMed, the Cochrane Library, the WHO regional databases and hand search of bibliographies. A standardized data abstraction and Child Health Epidemiology Reference (CHERG) adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) technique were used for data abstraction and overall quality of evidence. Meta-analyses were performed to calculate summary estimates of utility to the LiST model for the specified outcome of incidence of SGA births. We also evaluated the potential impact of multiple micronutrients on neonatal mortality according to the proportion of deliveries occurring in facilities (using a threshold of 60% to indicate functionality of health systems for skilled births).</p> <p>Results</p> <p>We included 17 studies for detailed data abstraction. There was no significant benefit of multiple micronutrients as compared to iron folate on maternal anemia in third trimester [Relative risk (RR) = 1.03; 95% confidence interval (CI): 0.87 – 1.22 (random model)]. Our analysis, however, showed a significant reduction in SGA by 9% [RR = 0.91; 95% CI: 0.86 – 0.96 (fixed model)]. In the fixed model, the SGA outcome remained significant only in women with mean body mass index (BMI) ≥ 22 kg/m². There was an increased risk of neonatal mortality in studies with majority of births at home [RR = 1.47, 95% CI: 1.13-1.92]; such an effect was not evident where ≥ 60% of births occurred in facility settings [RR = 0.94, 95% CI: 0.81-1.09]. Overall there was no increase in the risk of neonatal mortality [RR = 1.05, 95% CI: 0.92 – 1.19 (fixed model)].</p> <p>Conclusion</p> <p>This review provides evidence of a significant benefit of MMN supplementation during pregnancy on reducing SGA births as compared to iron-folate, with no significant increase in the risk of neonatal mortality in populations where skilled birth care is available and majority of births take place in facilities. Given comparability of impacts on maternal anemia, the decision to replace iron-folate with multiple micronutrients during pregnancy may be taken in the context of available services in health systems and birth outcomes monitored.</p

Short-course versus long-course antibiotic therapy for non-severe community-acquired pneumonia in children aged 2 months to 59 months

Background: Pneumonia is the leading cause of mortality in children under five years of age. Treatment of pneumonia requires an effective antibiotic used in adequate doses for an appropriate duration. Recommended duration of treatment ranges between 7 and 14 days, but this is not based on any empirical evidence. Shorter duration of therapy, if found to be effective, could be particularly important in resource-poor settings where there is a high risk of death, poor access to medicines and health care, and limited budgets for medicines.Objectives: To evaluate the efficacy of short- course versus long-course therapy with the same antibiotic for non-severe community-acquired pneumonia in children aged 2 to 59 months. Search strategy: We searched The Cochrane Central Register of Controlled Trials ( CENTRAL), the Database of Abstracts of Reviews of Effects ( DARE) ( The Cochrane Library, 2007, Issue 3), MEDLINE ( OVID) ( January 1966 to September 2007), EMBASE ( Embase. com) ( 1974 to September 2007), and LILACS ( 1982 to September 2007).Selection criteria: All randomized controlled trials ( RCTs) evaluating the efficacy of short- course versus long-course therapy using the same antibiotic for non- severe community-acquired pneumonia in children.Data collection and analysis: Two review authors independently assessed trial quality and extracted the data.Main results: Three studies ( 5763 children) were included. Analysis of three days versus five days of treatment with the same antibiotic for non-severe pneumonia in children showed non-significant differences in rates of clinical cure at the end of treatment (RR 0.99, 95% CI 0.97 to 1.01), treatment failure at the end of treatment ( RR 1.07, 95% CI 0.92 to 1.25) and relapse rate after seven days of clinical cure ( RR 1.09, 95% CI 0.83 to 1.42). Subgroup analysis evaluating the impact of different antibiotics showed non- significant differences for these outcomes with different durations of therapy. Authors\u27 conclusions: The evidence of this review suggests that a short course ( three days) of antibiotic therapy is as effective as a longer treatment ( five days) for non- severe pneumonia in children under five years of age. However, there is a need for more well-designed RCTs to support our review findings

Effect of administration of antihelminthics for soil transmitted helminths during pregnancy

Background: Helminthiasis is infestation of the human body with parasitic worms and it is estimated to affect 44 million pregnancies, globally, each year. Intestinal helminthiasis is associated with blood loss and decreased supply of nutrients for erythropoiesis, resulting in iron deficiency anaemia. Over 50% of the pregnant women in low- and middle-income countries suffer from iron deficiency anaemia. Though iron deficiency anaemia is multifactorial, hook worm infestation is a major contributory cause in women of reproductive age in endemic areas. Antihelminthics are highly efficacious in treating hook worm but evidence of their beneficial effect and safety, when given during pregnancy, has not been established.Objectives: To determine the effects of administration of antihelminthics for soil transmitted helminths during the second or third trimester of pregnancy on maternal anaemia and pregnancy outcomes.Search strategy: We searched the Cochrane Pregnancy and Childbirth Group\u27s Trials Register (September 2008). Selection criteria: All prospective randomised controlled trials evaluating the effect of administration of antihelminthics during the second or third trimester of pregnancy. Data collection analysis: Two review authors independently assessed trial quality and extracted the data.Main results: Three studies (1329 women) were included in this review. Analysis showed that administration of a single dose of antihelminth in the second trimester of pregnancy is not associated with any impact on maternal anaemia in the third trimester (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.68 to 1.19, random effects (2 studies, n = 1075)). Subgroup analysis on the basis of co-interventions other than antihelminthics which included iron supplementation given to both groups in the study by Larocque et al, and a subset of the study by Torlesse et al, showed that a single dose of antihelminth along with iron supplementation throughout the second and third trimester of pregnancy was not associated with any impact on maternal anaemia in the third trimester as compared to iron supplementation alone (RR 0.76, 95% CI 0.39 to 1.45, random-effects (2 studies, n = 1017)). No impact was found for the outcomes of low birthweight (RR 0.94, 95% CI 0.61 to 1.42 (1study, n = 950)), perinatal mortality (RR 1.10, 95% CI 0.55 to 2.22 (2 studies, n = 1089)) and preterm birth (RR 0.85, 95% CI 0.38 to 1.87 (1 study, n = 984)). Impact on infant survival at six months of age could not be evaluated because no data were available.Authors\u27Conclusion:The evidence to date is insufficient to recommend use of antihelminthics for pregnant women after the first trimester of pregnancy. More well-designed, large scale randomised controlled trials are needed to establish the benefit of antihelminthic treatment during pregnancy

Zinc supplementation as an adjunct to antibiotics in the treatment of pneumonia in children 2 to 59 months of age

Background:Diarrhoeal disorders and acute respiratory infections (ARIs), especially pneumonia, are the most common causes of death in low-income countries. Studies evaluating the impact of zinc supplementation as an adjunct in the management of pneumonia are limited and have shown variable results.Objectives: To evaluate zinc supplementation, as an adjunct to antibiotics, in the treatment (clinical recovery) of pneumonia in children aged two to 59 months.Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), which contains the Cochrane Acute Respiratory Infections (ARI) Group\u27s and the Cochrane Infectious Diseases Group\u27s Specialised Registers, MEDLINE (1950 to March week 2, 2011), EMBASE (1974 to March 2011), CINAHL (1981 to March 2011), LILACS (1985 to March 2011), AMED (1985 to March 2011), CAB Abstracts (1910 to March 2011) and Web of Science (2000 to March 2011).Selection criteria: Randomised control trials (RCTs) evaluating supplementation of zinc as an adjunct to antibiotics for pneumonia in children aged two to 59 months.Data collection and analysis: Two review authors independently assessed trial eligibility and screened all available titles and abstracts for inclusion. If the relevance could not be ascertained by screening the title and abstract, we retrieved and reviewed the full text of the article.Main results: We included four trials in which 3267 children aged two to 35 months participated. Analysis showed that zinc supplementation in addition to standard antibiotic therapy in children with severe and non-severe pneumonia failed to show a statistically significant effect on clinical recovery (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.93 to 1.11). Similary, zinc supplementation in children with severe pneumonia, as an adjunct to standard antibiotic therapy, did not show a statistically significant effect on clinical recovery measured as resolution of tachypnoea (respiratory rate \u3e 50 breaths per minute) (RR 1.13, 95% CI 0.82 to 1.57) and cessation of chest indrawing (RR 1.08, 95% CI 0.88 to 1.31) as compared to the control group. Zinc supplementation in children with severe pneumonia also showed a non-significant effect on the duration of hospitalization stay as compared to the control (RR 1.04, 95% CI 0.89 to 1.22).Authors\u27 Conclusion: Evidence provided in this review is insufficient to recommend the use of zinc as an adjunct to standard antibiotic therapy for pneumonia in children aged two to 35 months

Syntheses and crystal structures of mixed-ligand copper(II)–imidazole–carboxylate complexes

Crystallographic data for the structures in this paper have been deposited with the Cambridge Crystallographic Data Center, CCDC, 12 Union Road, Cambridge CB2 1EZ, UK. Copies of the data can be obtained free of charge on quoting depository numbers CCDC-1543434 (1), CCDC-1543435 (2) and CCDC-1543436 (3) (Fax:+44-1223-336–033; E-mail: [email protected]; http://www.ccdc.cam.ac.uk). Supplemental data for this article can be accessed at https://doi.org/10.1080/00958972.2018.1460471.Peer reviewedPostprin

Fistulotomy versus fistulectomy for simple fistula in ano: a retrospective cohort study

OBJECTIVE: To compare fistulotomy with fistulectomy for wound healing, duration of surgery, post-operative pain, incontinence and recurrence in patients with fistula in ano. METHODS: This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of adults who had undergone fistulotomy/fistulectomy for simple fistula in ano from January 2007 to August 2012. Data collection was done in August 2013 using questionnaire and telephonic interviews. Outcome variables like duration of wound healing, recurrence, incontinence, duration of surgery and post-operative pain were compared in both the groups. SPSS 19 was used for data analysis. RESULTS: Of the 192 cases, there were 96(50%) in each group. The mean age was 40.51 years (range: 21-72 years) in the fistulotomy group and 41.14 years (range: 21-66 years) in the fistulectomy group (p=0.66). Both groups were comparable for baseline demographic variables. The median duration of wound healing was shorter in the fistulotomy group 15 days (Interquartile range: 7-20 days) compared to the fistulectomy group 30 days (Interquartile range: 15-42 days) (p\u3c0.001). The incidence of recurrence was comparable in fistulotomy vs. fistulectomy (3[3.12%] vs. 4[4.16%]; p=0.70). The incidence of incontinence was higher in fistulotomy compared to fistulectomy (5[5.3%] vs. 12[12.5%]; p=0.07). The severity of incontinence was also compared but the difference was insignificant (p=0.06). The median duration of surgery was significantly shorter in fistulotomy group 17 minutes (Interquartile range: 12-25 minutes) compared to fistulectomy group 25 minutes Interquartile range: 20-35 minutes (p\u3c0.001). The median post-operative pain in the surgical day care unit and at the first follow-up in clinic was zero for both groups. CONCLUSIONS: Fistulotomy yielded better results than fistulectomy since it significantly decreased the duration of wound healing and duration of surgery without increasing the incidence of recurrence, incontinence and post-operative pain