Intergenerational consequences of in-utero and early-life conditions

This thesis comprises three self-contained chapters in applied microeconometrics, with an overall underlying theme of exploring the intergenerational transmission of effects of early-life conditions on human capital outcomes. Chapter 2 traces the impacts of in-utero exposure to negative rainfall shocks on the outcomes of grandchildren of those affected using representative survey data from the India Human Development Survey (IHDS). I find that (a) exposure to rainfall shock during pregnancy has strong negative effects that pass down to health and cognitive ability of the third generation; and (b) biological explanation, plausibly genetic and epigenetic inheritance, may be the key transmission mechanism of these effects. Chapter 3 investigates the gender-differential response of parents’ expenditure to changes in child’s health due to negative rainfall shocks in early childhood. I link the rural sample of Young Lives survey for Andhra Pradesh, India with the district-level monthly rainfall data, and use an instrumental variable framework. Findings show that when negative rainfall shocks adversely affect children during early childhood, parents compensate by investing more in their education. My results uncover gender discriminatory investment behaviour, where parents invest more in education of a boy as compared to a girl. Chapter 4 analyses the intergenerational effects following the positive changes in women’s inheritance rights. I employ a difference-in-differences strategy and exploit the state level variation in a woman’s exposure to the Hindu Succession Amendment Act in India. Using the IHDS data, I find that the property rights reform significantly increased the health of children whose mothers were exposed to the amendment. Further analysis reveals a substantive gender-differential pattern; the health of daughters is significantly worse than that of sons, but is only visible in children with less educated mothers. I discuss mothers’ improved bargaining power in household decisions as the main channel through which the reform operates

Gender Gaps in Child Nutritional Status in Punjab, Pakistan

Child nutritional status has improved over the period 2008 to 2014 in Punjab, Pakistan's largest province with a population of over 100 million, as rates of severe stunting have declined by 8.6 percentage points and average height-for-age (HFA) has increased by 0.19 standard deviations. However, the nutritional status of children in Punjab is still quite poor in comparison to many Sub-Saharan African countries. Recent research from India suggests eldest son preference and son-biased fertility stopping patterns negatively impacts the nutritional status of other children in the household, especially daughters. In order to test for latent gender discrimination in Punjab, Pakistan, a culturally similar neighbour, we apply a finite mixture model to a sample of couples with at least one child of each gender, though we do not find any. We do find, however, that when there is a larger share of children without an elder brother, that is, there is no son or a son is born after several daughters, that the incidence of stunting is higher and average HFA z-score of a couple’s children is lower, using an OLS analysis. This suggests that some families might be increasing their fertility beyond the number of children they can support in pursuit of sons. In this way, couples’ preferences regarding the gender composition of their children can have subsequent effects on the long- term nutritional status of their children. JEL Classification: I2, I14, I15 Keywords: Pakistan, Height-for-Age, Gender, Finite Mixture Mode

Knowledge about asthma: A cross-sectional survey in 4 major hospitals of Karachi, Pakistan

Objective: To determine knowledge and misconceptions about asthma among the local population..Methods: This cross-sectional study was conducted at four tertiary care hospitals; Aga Khan University Hospital, Civil Hospital Karachi, Jinnah Postgraduate Medical Centre and Ojha Institute of Chest Diseases, Karachi, from October to November 2016, and comprised hospital attendants. The questionnaire used in the study comprised 26 questions answered with a true, false or not sure answer.SPSS 20 was used for data analysis.Results: There were 400 participants. The overall mean age was 41.2±14.2 years, and 214(53.5%) of the participants were males. Moreover, 75(19%) participants thought that asthma was a psychological disorder while 181(45%) considered it an infectious disease. Nearly 174(43.5%) believed that inhaled medications had significant side effects. Besides, 264(66%) participants considered steam inhalation to be an effective treatment for asthma, 269(67%) thought that patients with asthma should avoid rice in their diet and 167(42%) considered milk as a common trigger.CONCLUSIONS: Participants\u27 knowledge about asthma was poor and misconceptions were common about the condition

Endovascular Stenting in Superior Vena Cava Syndrome: A Systematic Review and Meta-analysis

PURPOSE: Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). METHODS: MEDLINE, EMBASE and PUBMED online databases were searched, with studies involving more than ten adult patients included. Studies identified spanned 27 years, from 1993 to 2020. Meta-analyses were performed based on Clopper-Pearson estimation. RESULTS: Fifty-four studies were identified, for a total of 2249 patients, of which 2015 had malignant SVCS and 222 benign SVCS. Pooled technical success and clinical success rates were 96.8% (95% CI 96.0-97.5%) and 92.8% (95% CI 91.7-93.8%). Technical success and clinical success rates for studies investigating benign SVCS alone were identical at 88.8% (95% CI 83.0-93.1%). Pooled patency remained above 90% for the first year. Average complication and re-intervention rates were 5.78% (SD = 9.3182) and 9.11% (SD = 11.190). CONCLUSIONS: This review confirms the effectiveness of endovascular stenting in managing SVCS. Further directions of research may include specific outcomes of endovascular stenting in benign SVCS, and the impact of procedural characteristics, such as the use of anticoagulation and type of stent used, on outcomes. LEVEL OF EVIDENCE: Level III, systematic review of retrospective cohort studies

Orthokeratinized odontogenic cyst (OOC): Clinicopathological and radiological features of a series of 10 cases

Background: Orthokeratinized Odontogenic Cyst (OOC) is a rare, developmental odontogenic cyst which was considered in the past to be a variant of Odontogenic keratocyst (OKC) later renamed as keratocystic odontogenic tumor (KCOT). The treatment of OOC is by enucleation and the prognosis, following enucleation is excellent with a recurrence rate of less than 2%. On the other hand, OKC has a recurrence rate between 8 and 25% after enucleation. Thus it is important to differentiate between the two entities.Methods: All cases reported in our section as OOC during the period 2013 to 2018 were retrieved from the surgical pathology files and slides were reviewed by the authors. All cases which met the histological criteria for OOC were included.Results: A total of 10 cases were included. 70% patients were males, ages ranged from 23 to 60 years, with mean age of 38.9 years. 70% of cases were located in the mandible and 90% patients presented with swelling. Radiologically, 90% cases were unilocular, all were radiolucent lesions. Mean size was 4.0 cm. Histologically, all cases demonstrated the classic microscopic features. Follow-up was available in 8 patients. All were treated by enucleation. All 8 were alive with no recurrences over a follow-up period ranging from 7 to 62 months.Conclusions: OOC has a better prognosis than OKC and needs to be differentiated from OKC due to differences in treatment and prognosis. Large majority of our cases presented with swelling and occurred in the mandibles of young males. All were radiolucent and most were unilocular. All were treated by enucleation and no recurrences occurred over follow up period ranging up to 62 months. Our findings were similar to those described in other published series

Comparative Analysis of Different Remote Sensing Techniques for Mapping of Supraglacial Lakes on Hispar Glacier

The glacier changes are very significant in quantifying the direct effects of climate change. The glaciers inthe northern Pakistan especially in the Karakoram pose a large change in relief and are difficult to access due tocomplex topography. The global WOS (Web of Science) database indicate only a few studies conducted so far in thisregion in the domain of climate and cryosphere. The studies relating to glacial hazards in this region are even less. Thisstudy involves the mapping of supraglacial lakes on Hispar glacier using multiple remote sensing methods. Theaccuracy of results from those methods is discussed. Remote Sensing and GIS techniques have been applied to timeseries of Landsat images of years 2017, 2016, 2010, 2000 and 1990 (in the descending order) to quantify thesupraglacial lakes on the Hispar glacier. The remote sensing techniques include Band Rationing, Normalized WaterIndex (NDWI), Classification i.e. Unsupervised and Panchromatic Sharpening Image Enhancement Technique for theyears of 2017 and 2016 imageries. After defining the Hunza basin (involving of high resolution DEMs), all the satellitederived imageries have been preprocessed and processed. GIS tools have been used to calculate the areal extents ofyearly obtained supraglacial lakes and compare temporally with passing years, which in turn gave an accuratecomparative analysis among different remote sensing techniques. The satellite derived time series map layouts of eachtechnique have been formulated. The vulnerable supraglacial lakes on Hispar glacier of areal sizes ≤ 0.05 sq.km havealso been identified and delineate

Successful resection of lymphangioma of the neck and mediastinum presenting as stridor in a 12 year old child

Lymphangiomas are congenital malformations of lymphatic tissue. This benign condition is generally found in the neck region and is discovered by 2 years of age. Here we report the case of a 12 year old child who presented with a cervical and mediastinal cystic hygroma that had progressed to such a space occupying nature as to cause the shifting of the trachea. The entire mass was successfully resected with a lower neck incision. Our case suggests the necessity of considering cystic lymphangioma in the differential diagnosis of lateral neck masses and use of adequate imaging to substantiate the preoperative diagnosis