Medical and Dental Consultants’ Association of Nigeria
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   Table of Contents - Current issue
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March 2017
Volume 20 | Issue 3
Page Nos. 267-398

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ORIGINAL ARTICLES  

An exploratory study of patients’ perceptions of responsiveness of tertiary health-care services in Southeast Nigeria: A hospital-based cross-sectional study Highly accessed article p. 267
MD Ughasoro, OC Okanya, BSC Uzochukwu, OE Onwujekwe
DOI:10.4103/1119-3077.183255  PMID:28256478
Background: The achievement of universal health coverage in Nigeria requires evaluating the extent the expectation of those who have utilized health-care services are met. The study assessed the level of clients’ perceived responsiveness of tertiary hospitals in the provision of specialist health-care services in Nigeria. Methods: A hospital-based, cross-sectional study was conducted among adult patients and caregivers of children on admission in three tertiary health facilities in Southeast Nigeria. Data were collected from 137 respondents using a questionnaire that was adapted from the World Health Organization-structured responsiveness questionnaire. The key variables were on (a) respect for persons (dignity, confidentiality, and autonomy of individual) and (b) client orientation (prompt attention, access to social network during care, quality of basic amenities, and choice of provider), and data were analyzed using multivariate methods. Results: The choice of care provider (80.0%) and autonomy (80.9%) were the lowest perceived responsiveness domains while prompt attention (89.2%) and dignity (87.7%) were rated highest by respondents. Multivariate analysis found significant association between gender and some responsiveness domains such as autonomy (P = 0.024), prompt attention (P = 0.003), and quality of basic amenities (P = 0.015) and between occupation and prompt attention (P = 0.034). Conclusions: Many critical aspects of specialist services in tertiary hospitals do not respond to clients’ need while some do. It is important that poorly performing domains of services are strengthened, especially with upgrading the quality of basic infrastructure so as to improve the performance of the tertiary hospitals.
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Is 2 mm a safe distance from the inferior alveolar canal to avoid neurosensory complications in implant surgery? Highly accessed article p. 274
S Tufekcioglu, C Delilbasi, G Gurler, E Dilaver, N Ozer
DOI:10.4103/1119-3077.183240  PMID:28256479
Aim: The aim of the present study was to compare the neurosensory complications related to implants inserted closer than 2 mm to the inferior alveolar canal (IAC) with those inserted further than 2 mm. Materials and Methods: A total of 474 implants in 314 patients placed posterior to mental foramen area were evaluated retrospectively on panoramic radiographs. Patients were divided into two groups regarding implant proximity to the IAC (Group 1, distance ≤2 mm, Group 2, distance >2 mm). Postoperative neurosensory complications (pain and paresthesia) were recorded. Chi-square test was used for statistical comparison and P ≤ 0.05 was considered significant. Results: One hundred and fifty-three implants (32.2%) were inserted closer than 2 mm to the IAC whereas 321 implants (67.8%) were inserted further than 2 mm. Three implants which had a distance of 0 mm to the IAC (0.63%) caused paresthesia after surgery. Implant distance to IAC did not show a significant difference regarding pain and paresthesia (P = 0.06 and P = 0.08, respectively). Conclusion: When 2 mm is considered as a safety distance, the distance of the implants to the IAC did not yield any statistical difference regarding postoperative neurosensory complications.
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Multiple primary cancers: Simultaneously occurring prostate cancer and other primary tumors-our experience and literature search p. 278
AA Popoola, OO Abiola, T Buhari, AF Ushie, HB Olanipekun, AK Arogundade
DOI:10.4103/1119-3077.187331  PMID:28256480
Introduction: Prostate cancer is a leading cause of death in men all over the world, and it is becoming an increasing public health burden in sub-Saharan Africa. In our practice, we identified that prostate cancer co-existed with other primary cancers even in noncontiguous regions of the body and this co-existence impacted on our management of these patients. Materials and Methods: We retrospectively studied a 2-year period (June 2012-July 2014), the records of patients in our hospital with prostate cancer, who in addition, had other primary cancers; and studied the management and outcomes of these patients. We also reviewed the existing literatures for possible biologic links between prostatic carcinoma and other primary tumors. Results: There were six patients with multiple primary cancers who had prostate cancers. The age range was 60-84 years and the mean age of 72.2 ± 0.4 years. The primary tumors co-existing with prostate cancer were colonic adenocarcinoma, rectal adenocarcinoma, urinary bladder transitional cell carcinoma, primary liver cell carcinoma, and thyroid follicular carcinoma in both synchronous and metachronous relationships. Conclusions: Prostate cancers often co-exist with other cancers. The precise mechanism by which prostate cancer co-exists with another primary cancer is yet to be clearly defined. With more study of the syndromic cancers involving the prostate, definite associations could be identified, and this may help in managing these patients better.
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Spectrum and outcome of neonatal emergencies seen in a free health-care program in South-Western Nigeria p. 283
MT Abiodun, RO Oluwafemi
DOI:10.4103/1119-3077.187324  PMID:28256481
Background: Neonatal emergencies contribute significantly to under-five morbidity and mortality in developing countries, partly due to poverty and limited access to quality healthcare in rural communities. Aims: The aim is to evaluate the spectrum, outcome, case fatality rates (CFRs), and prognostic factors of neonatal emergencies seen in the two free health-care facilities in Ondo State. Methods: This was a cross-sectional descriptive study of neonatal emergencies. Data were collected on eligible consecutive infants using a self-designed questionnaire. Neonatal emergencies were classified based on systemic involvement and underlying causes. Categorized data were expressed as percentages. Outcome and CFRs were presented pictorially. Inferential analysis was performed. The value of P < 0.05 was considered statistically significant. Results: Altogether, 425 infants with neonatal emergencies were recruited, constituting 21.3% of the under-five medical emergencies managed during September 2014 to February 2015. The most frequent emergencies were neonatal sepsis (45.2%) and neurological emergencies, especially hypoxic ischemic encephalopathy (22.1%) and acute bilirubin encephalopathy (14.6%). Furthermore, 6.1% of the infants presented with disseminated intravascular coagulopathy. The outcome of the emergencies was as follows: 88.6% were discharged, 7.4% died, and 3.7% left against medical advice whereas 0.3% were referred for subspecialty services. The leading causes of death among the 32 mortalities in this survey were sepsis (39.5%), hypoxic ischemic encephalopathy (36.9%), and hypothermia (13.2%). Hypothermia, perinatal asphyxia, and hypoglycemia had the highest CFRs, 22.7%, 12.6%, and 11.8%, respectively. Conclusion: Neonatal encephalopathy and sepsis were the most common emergencies seen in the free health-care program. Furthermore, they accounted for a majority of the neonatal deaths. This should be taken into cognizance while designing local interventions for neonatal emergencies.
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The antifungal activity and cytotoxicity of silver containing denture base material p. 290
A Kurt, G Erkose-Genc, M Uzun, Z Emrence, D Ustek, G Isik-Ozkol
DOI:10.4103/1119-3077.181362  PMID:28256482
Objective: Denture base materials are susceptible to fungal adhesion, which is an important etiological issue in the pathogenesis of denture stomatitis. The purpose of this in vitro study was to evaluate the antifungal activity and cytotoxicity of denture base material containing silver microparticles. Materials and Methods: The polymethyl methacrylate (PMMA) denture base material was used, and silver microparticles were added to the polymer powder in different concentrations by volume (0%, 0.25%, 0.5%, and 1%). Their antifungal activity against Candida albicans was assessed in terms of colony-forming units. PMMA disc specimens containing silver microparticles were eluted with culture medium for 1, 2, and 5 days. The cytotoxicity of the eluates to cultured L929 mouse fibroblast cells was evaluated using a real-time cell analysis (RTCA) system and the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay. Results: The antifungal effect against C. albicans increased with the percentage of silver microparticles (P < 0.05). For both tests, both RTCA and the MTT assay, no time- or silver-dependent cytotoxicity of PMMA denture base material containing silver microparticles was observed. Conclusions: PMMA denture base material containing silver microparticles have antifungal activity and no cytotoxic effect.
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Psychosocial factors predicting severity of depression among treatment-seeking HIV/AIDS patients: A multi-site Nigerian study p. 296
BO Olley, KO Adebayo, MJ Ogunde, A Ishola, AP Ogar
DOI:10.4103/1119-3077.201432  PMID:28256483
Background and Objectives: Depression as major psychological sequelea of the HIV/AIDS infection has continued to attract investigation. With few studies in Nigeria, it is unclear whether levels of perceived stigma, sexual risk behaviors, and anticipated discrimination are differentially associated with severity of depression. Materials and Methods: The present study using a multivariate design investigated the role of stigma, anticipated discrimination, self-esteem, HIV-related factors (e.g., drug use combination, knowledge of duration of HIV diagnosis) and socio demographic factors (e.g., multiple spouse, age, gender, and ethnicity) in depression among people living with HIV/AIDS (PLWHA) on follow-up management in three tertiary hospitals in Nigeria. Five hundred and two (187 [37.3%] males and 315 [62.7%] females) HIV/AIDS patients participated in the study. Results: Mean age and mean time in months since diagnosis were 36.73 ± 9.38 and 19.42 ± 23.12, respectively. Three variables: Ethnicity, anticipated discrimination, and HIV-related stigma were related to severity of depression at (P < 0.05). Multinomial logistic regression analyses showed that being from Yoruba (odds ratio [OR] = 0.25; 95% confidence interval [CI] = 0.145-0.441), or Igbo extraction (OR = 0.43; 95% CI = 0.214-0.873) reduces the risk of reporting severity of depression by 25% and 43%, respectively. Moreover, low perceived HIV-related stigma (OR = 0.59; 95% CI = 0.355-0.966) and low anticipated discrimination (OR = 0.54; 95% CI = 0.319-0.914) reduced the risk of reporting symptoms of severe depression by 59% and 54%, respectively. Conclusion: Intervention to reduce the severity of depression should consider cultural specificity in its design and also evolve educational programs that incorporate discrimination and stigma in managing depression among PLWHAs.
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Cecal intubation rate during colonoscopy at a tertiary hospital in South-West Nigeria: How frequent and what affects completion rate? p. 303
A Akere, KO Akande
DOI:10.4103/1119-3077.187334  PMID:28256484
Background: Colonoscopy is useful in the diagnosis, treatment of colorectal diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR). Aim: This was to assess the CIR at our endoscopy unit and evaluate the factors responsible for uncompleted cases. Patients and Methods: This was a prospective study at the endoscopy unit of the University College Hospital, Ibadan. All consenting patients referred for colonoscopy were recruited into the study. Colonoscopy was performed per protocol, and cecal intubation was considered successful when the medial wall of the cecum was intubated. Results: Total of 305 colonoscopies were performed comprising 168 (55.1%) males and 137 (44.9%) females. Mean age was 57.5 ± 14.0 years (range 15-90 years). The crude CIR was 89.2%, whereas the adjusted CIR was 95.1%. Completion rate was higher in males, in patients who were younger than 58 years and in patients with adequate bowel preparation. Conclusion: CIR in our practice is high and comparable to the recommended rates. Female gender, age older than 58 years, and inadequate bowel preparation had a crude association with lower CIR, but this was not statistically significant.
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Evaluation of various filling techniques in distal canals of mandibular molars instrumented with different single-file nickel-titanium systems p. 307
A Dumani, S Yilmaz, O Yoldas, C Kuden
DOI:10.4103/1119-3077.178920  PMID:28256485
Background and Aims: The aim of this study was to evaluate the quality of various filling techniques in distal canals of mandibular molars instrumented with different single-file nickel-titanium (NiTi) systems. Materials and Methods: A total of 150 distal roots of mandibular molar teeth were randomly assigned into three main groups and instrumented by using Reciproc (VDW, Munich, Germany), WaveOne (Dentsply Tulsa, Tulsa, OK, USA), or One Shape (MicroMega, Besancon, France) NiTi file systems. The roots were then treated using one of five filling techniques: (1) Matched-single-cone, (2) cold lateral compaction with matched gutta-percha (GP) cone, (3) Thermafil filling, (4) System B/Obtura II, and (5) lateral compaction with standardized GP cones. The roots were then sectioned at three levels (coronal, middle, and apical). Photographs were acquired under a stereomicroscope, and the percentage of GP-filled areas (PGFAs), percentage of sealer-filled areas (PSFAs), and voids were measured using the ImageJ software. Comparisons between groups were applied using Student’s t-test or one-way ANOVA for normally distributed data. The Mann-Whitney U-test or Kruskal-Wallis test was used when variables were not normally distributed. Results: Canals filled with the System B/Obtura showed the highest PGFA and lowest PSFA, whereas those filled with matched-single-cone showed the highest PSFA and lowest PGFA (P < 0.05). The cold lateral compaction with matched GP cone group, lateral compaction group, and Thermafil filling group showed no statistically significant differences in PSFA and PGFA (P > 0.05). Conclusions: System B/Obtura technique appears to be the best technique to properly fill root canals, whereas the matched-single-cone technique in oval-shaped distal canals of mandibular molars was inadequate.
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The prevalence of chronic kidney disease and associated factors among patients admitted at princess marina hospital, Gaborone, Botswana p. 313
GM Rwegerera, M Bayani, EK Taolo, D Habte
DOI:10.4103/1119-3077.187335  PMID:28256486
Background: Chronic kidney disease (CKD) has become a major public health problem worldwide. Due to the asymptomatic nature of CKD during earlier stages, patients tend to present late, missing opportunities for prevention. Aims: This study was conducted to determine the prevalence and assess the risk factors associated with CKD in patients admitted at Princes Marina Hospital. Settings and Design: Hospital inpatient setting. Subjects and Methods: A case-matched comparison study was done involving 86 cases and 86 matches by gender and age (± 5 years) from March 21, 2014, to May 31, 2014. Statistical Analysis Used: SPSS software version 20 (SPSS Inc. Chicago Illinois) was used for data entry, cleaning, and analysis. Frequency, percentage, mean, and standard deviation were used to describe the data. Chi-squared test and odds ratio (OR) with 95% confidence interval (CI) were employed to analyze the associations of categorical variables. Logistic regression analysis was done to control for possible confounding variables. A P < 0.05 was considered statistically significant. Results: In the study period, CKD prevalence was 74/550 (13.5%), and 23/99 (23.2%) of mortality occurred in patients with CKD. Over half of the 86 cases of CKD (53.5%) were not aware of their CKD status and were diagnosed during the index admission. Hypertension (HTN), diabetes mellitus, and HIV-positive status were significantly associated (P < 0.05) with CKD in the bivariate analysis, while HTN (adjusted OR [AOR] [95% CI]: 11.28 [4.56, 27.89]) and HIV-positive status (AOR [95% CI]: 8.68 [3.58, 20.99]) remained significant predictors of CKD in the multivariate analysis. CKD within the HIV-positive patients was significantly associated with duration of <3 years since HIV diagnosis and lower CD4 levels (P < 0.05). Conclusions: Significant admissions and mortality in medical wards are attributed to renal impairment. There is an urgent need to establish follow-up programs in high-risk populations (hypertensives, diabetes, and HIV) which aims to identify patients at early stages of CKD, and devise prevention mechanisms to reduce burden in terms of cost, morbidity, and mortality.
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Macrosomic births in abuja: A case–control study of predisposing factors and early neonatal outcome p. 320
RN Akindele, LI Audu, OA Mokuolu
DOI:10.4103/1119-3077.196060  PMID:28256487
Background: Although research has shown that having a macrosomic fetus could be predictive of a negative pregnancy outcome, the factors that control its incidence and the outcome of delivery management have been less well characterized in Africa. The aim of this study was to identify specific predispositions and the factors that influence the early neonatal outcome of macrosomic infants in Abuja. Methods: Data from 120 mother and macrosomic (weighing ≥4000 g) newborn pairs, and an equal number of mother and normal weight (2500–3999 g) matched controls, delivered over a 5-month period at three large hospitals in Abuja, Nigeria, were analyzed. Chi-square and logistic regression analyses were performed for various predisposing factors and neonatal outcomes of macrosomic births. Results: The incidence of macrosomia was 77 per 1000 births. Independent predictors of macrosomia were parental high social class (P = 0.000), gestational weight gain of ≥15 kg (P = 0.000), and previous history of macrosomia (P = 0.002). The most frequent route of delivery was emergency cesarean section accounting for 51 (42%) births. Macrosomia was significantly associated with higher rates of birth injuries (P = 0.030), perinatal asphyxia (P = 0.015), admissions into the special care newborn unit (P = 0.000), and hypoglycemia (P = 0.000). Although the difference in the early neonatal mortality rates between the macrosomic group (2.5%) and the control group (0.8%) was not statistically significant, nearly 70% of deaths in the macrosomic group were associated with severe perinatal asphyxia. Conclusion: Our findings highlight the need for improved anticipatory care of the macrosomic fetus at delivery, in Africa.
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Effects of seven different irrigation techniques on debris and the smear layer: a scanning electron microscopy study p. 328
M Yilmaz, S Yılmaz, A Dumanı, C Kuden, O Yoldas
DOI:10.4103/1119-3077.180061  PMID:28256488
Aim: Conventional manual irrigation with a syringe and needle remains widely accepted technique in the irrigation procedures. However, its flushing action has some limitations. Currently, several techniques and systems are available and reported to improve the insufficiency of syringe irrigation. The aim of this study was to evaluate the effectiveness of 7 different irrigation techniques compared to standard irrigation. Materials and Methods: Straight roots from 80 extracted human maxillary central incisors were collected, and root canals were instrumented with K-files up to apical size 50. The teeth were randomly divided into 8 groups (n = 10), and final irrigation procedures were performed with 17% ethylenediaminetetraacetic acid and 5.25% NaOCl solutions using following irrigation agitation techniques: RinsEndo, EndoVac, Canal CleanMax, sonic, Canal Brush, NaviTip FX, manual dynamic irrigation, and conventional irrigation. The presence of debris and smear layer (SL) at coronal, middle, and apical thirds was evaluated by using a 5-grade scoring system with ×200 and ×1000 magnification, respectively. Results: Concerning debris removal, the MM 1500 sonic group reduced apical debris significantly better than the other groups tested (P < 0.05). There was no significant difference among the tested groups (P > 0.05) related SL removal in all levels. Conclusions: MM 1500 scored best with debris removal; however, there was no significant reduction in the SL in apical third with any of the methods tested.
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Outcome of strabismus surgery by nonadjustable suture among adults attending a university hospital of Saudi Arabia p. 335
FA Al-Wadaani
DOI:10.4103/1119-3077.196086  PMID:28256489
Objective: To describe the outcome and safety of surgical treatment of Saudi adult patients with strabismus by nonadjustable suture and to evaluate the prevalence of diplopia and binocularity after strabismus correction. Materials and Methods: Retrospective analysis of medical records of 96 patients above the age of 16-years old with strabismus seen at the King Fahd Hospital of the King Faisal University (KFUH) from July 1st, 2000 to June 30th, 2007 who were underwent strabismus correction surgery. The demographic variables: pre- and post-operative alignment, binocularity, and visual acuity were analyzed. Results: A total of 96 patients of whom 63 (66%) patients were male and 33 (34%) patients were female, aged 16 years and above underwent strabismus correction, 83 (86%) patients ended with postoperative orthophoria, 13 (14%) patients ended with postoperative residual deviation, 83 patients (86%) had defective vision with amblyopia. Improvement of binocularity and binocular visual acuity postoperatively was achieved in 32(33%). Forty (42%) of our patients developed transient diplopia postoperatively which disappeared within 6 weeks while only three developed permanent diplopia. The main cause of adult strabismus was childhood squint in 83 (86%) patients and traumatic in 3 (13%). Conclusion: Surgical treatment of strabismus in Saudi adult with nonadjustable suture is safe and effective procedure with low risk of complication and the incidence of diplopia is rare with better binocularity and binocular visual acuity.
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Retinal imaging with smartphone p. 341
DS Ademola-Popoola, VA Olatunji
DOI:10.4103/1119-3077.201428  PMID:28256490
Background: The use of smartphones for various purposes among health professionals is increasing, especially with the availability of different applications. On account of cost, fundus cameras are not readily available in ophthalmic practice in developing countries. Since smartphones are readily available, easy to use and portable, they may present a cheap alternative in a resource-limited economy. Aim and Objectives: to explore the use of smartphone (Blackberry Z-10) for retinal imaging in a resource-limited economy. Methods: A smartphone (Blackberry Z-10) was used to acquire retinal images with the use of +20D lens in patients with dilated pupils by activating the video mode of the camera. Results: Clear retinal images were obtained in different clinical conditions in adults and children including branch retinal vein occlusion with fibrovascular proliferation, chorioretinal scarring from laser photocoagulation, presumed ocular toxoplasmosis, diabetic retinopathy, retinoblastoma, ocular albinism with fundus hypopigmentation. Conclusion: The ability to have low cost fundus imaging from readily available smartphones in an eye clinic in Nigeria presents a major boost to patient care and also offers an innovative role in research, education, and information sharing.
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Radiographic findings of bisphosphonate-related osteonecrosis of the jaws: Comparison with cone-beam computed tomography and panoramic radiography p. 346
A Demir, FN Pekiner
DOI:10.4103/1119-3077.183241  PMID:28256491
Objective: The aim of this study is to assess radiographic findings of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and to evaluate the efficiency of cone-beam computed tomography (CBCT) and panoramic radiography (PR) by comparing with each other. Materials and Methods: The data of 46 patients treated with bisphosphonates for at least 1 to 10 years were retrospectively examined. 27 patients were selected for study group. The first inclusion criteria was an available CBCT or PR. The patients had at least one clinical symptom of exposed bone, intraoral or extraoral swelling and purulent secretion or fistula formation. In accordance with the position papers of the American Association of Oral and Maxillofacial Surgeons, the patients were classified into stages. CBCT and PR images were evaluated by dividing the jaws in 6 segments. Presence of bone sclerosis, cortex irregularity, persistent sockets, periosteal response, sequestration, and osteolysis were recorded. Results: The radiographic findings of BRONJ were mostly determined at posterior mandible with Stage 2 predominancy. Fifteen patients (55.6%) had previous tooth extraction. 9 of them had exposed bone at the same time. Seven patients had exposed bone without extraction. CBCT findings (P < 0.01) except persistent socket (P = 0.157) were found statistically significant by comparison with PR. Extraction socket finding was detected the same in segments with a percentage of 90.9%. Conclusion: This study showed that CBCT findings except extraction socket were significantly higher than PR. CBCT combined with clinical examination can be used effectively to determine the borders of effected areas especially at advanced cases.
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Evaluation of candida albicans biofilm formation on various dental restorative material surfaces p. 355
N Beldüz, A Kamburoğlu, Y Yılmaz, İ Tosun, M Beldüz, C Kara
DOI:10.4103/1119-3077.198388  PMID:28256492
Aims: Candida adhesion to any oral substrata is the first and essential stage in forming a pathogenic fungal biofilm. In general, yeast cells have remarkable potential to adhere to host surfaces, such as teeth or mucosa, and to artificial, nonbiological surfaces, such as restorative dental materials. This study compared the susceptibility of six dental restorative materials to Candida albicans adhesion. Materials and methods: Cylindrical samples of each material were made according to the manufacturersa instructions. The antifungal effect of the samples on C. albicans was determined with the disc-diffusion method. The samples were put in plates with sterile Mueller Hinton and Sabouraud dextrose agar previously seeded with C. albicans. After the incubation period, the inhibition zone around each sample was evaluated. To evaluate the biofilm formation, the XTT technique and scanning electron microscopy (SEM) were used. Results: No inhibition zone was observed around the samples. According to the XTT assays, the amalgam samples revealed the lowest quantity of biofilm formation (P > 0.001). The highest median XTT values, significantly higher than the other materials (P < 0.001), were found for the composite and the compomer samples. Within the SEM examination, the amount of candidal growth was significantly lower on the resin-modified glass ionomer and glass-ionomer cement samples. The compomer and the composite samples showed more candidal adhesion. Conclusion: This finding emphasizes the use of glass ionomer restorative cements and amalgam to reduce C. albicans adhesion to dental restorative materials especially in people with weakened immune systems, neutropenia, and cancer.
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The effect of nonsurgical periodontal treatment on serum and gingival crevicular fluid markers in patients with atherosclerosis p. 361
AS Ertugrul, A Bozoglan, M Taspınar
DOI:10.4103/1119-3077.181369  PMID:28256493
Background and Aims: The aim of this study is to compare patients with atherosclerosis and chronic periodontitis and patients who are systemically healthy and chronic periodontitis using alteration of adrenomedullin (ADM), chemokine (C-C motif) ligand 28 (CCL-28), white blood cell levels, platelet levels, high-density lipoprotein, low-density lipoprotein, high-sensitivity C-reactive protein, creatinine, and fibrinogen. Materials and Methods: Totally, 40 patients were involved in study; a test group of 20 patients with atherosclerosis-chronic periodontitis and a control group of 20 patients who were nonatherosclerosis-chronic periodontitis. Nonsurgical periodontal treatment was offered to all patients, in whom systemic markers of atherosclerosis were measured in serum; ADM and CCL-28 biomarkers were measured in gingival crevicular fluid. Results: Systemic markers of atherosclerosis, ADM, and CCL-28 levels have changed significantly in the test group compared to the control group after nonsurgical periodontal treatment. Conclusions: Treatment of local inflammation and reduction of systemic inflammatory markers are believed to lower the diagnostic criteria for atherosclerosis as well. It is possible to conclude that nonsurgical periodontal treatment of chronic periodontitis, which is a risk factor for atherosclerosis, has a positive effect on the atherosclerosis prognosis.
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Total knee replacement in a resource constrained environment: A preliminary report p. 369
UE Anyaehie, GO Eyichukwu, CU Nwadinigwe
DOI:10.4103/1119-3077.196117  PMID:28256494
Introduction: Total knee replacement surgery is relatively new in Nigeria and available in few centres only. It has been evolving at a slow pace because of the lack of facilities, structures and adequate surgical expertise alongside patient ignorance and poverty. Objective: The aim of this article is to review the cases done in a resource constrained institution in Nigeria and report the short term outcomes. Methodology: All the patients that were booked for Total knee replacement, using same prosthesis over a 40 month period, were recruited into the study. Using a prepared data tool, information on personal biological information, clinical presentation, peri-operative management, and outcome of management were obtained after an informed verbal consent. All the patients were further followed up for at least one year. Results: 45 knees were replaced in 38 patients. The age range of the patients was 41–85 years with a mean age of 62.6. The male to female ratio was 1: 4.4. The indications for surgery were a combination of pain and deformity. All the patients came with varying forms and degrees of angular deformities. Eight knees had bone defects that required bone grafting while 5 knees had tibia extension rods. The commonest complication, which was recorded, was drop foot (8.9%). Knee society pain scores in the patients improved from the average of 21.35 to 83. Conclusion: Despite the challenges inherent in health care in developing countries, with proper institutional planning and team work, the short term outcome of arthroplasty in our resource constrained environment is good.
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The evaluation of renal parenchymal scarring using static renal scintigraphy after percutaneous nephrolithotomy operations p. 376
S Yalcinkaya, N Ates, M Yuksel, E Islamoglu, H Tokgoz, EU Ates, A Yildız, S Yilmaz, M Savas
DOI:10.4103/1119-3077.187318  PMID:28256495
Objective: To analyze whether operative techniques and other variables related to patient and renal stone characteristics affect potential renal parenchymal damage. Materials and Methods: The study population comprised 64 patients who underwent percutaneous nephrolithotomy operations (PCNL). Data of the operated renal units, renal stone burden, route and number of entries, dilation techniques, duration of surgery, preoperative and postoperative glomerular filtration rate (GFR) and relative dimercaptosuccinic acid (DMSA) uptakes, as well as the changes in hemoglobin values, were recorded and analyzed for all patients. Results: The mean age of the patients was 44 years. In 11 (17.1%) cases, renal cortical defects in the 3rd month were detected on DMSA scintigraphy. When the patients with and without renal cortical defect were compared regarding their preoperative and postoperative GFR values, no statistically significant difference was noticed between the groups (P > 0.05). Similarly, when postoperative relative DMSA uptakes were compared with preoperative relative DMSA uptakes of the same kidneys, no statistical significance was seen. When preoperative relative DMSA uptake values between groups with and without renal scarring were compared, no statistically significant difference was observed (P > 0.05). Conclusion: We did not observe any significant difference in scintigraphic parameters and GFR values. Hence, in the current trial, significant loss in renal function after PCNL operations was not observed. Thus, PCNL operations should be regarded as safe, but still, the risk of loss of kidney function should always be considered.
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Diagnostic methods for dental caries used by private dental practitioners in Ankara p. 382
UK Vural, S Gökalp
DOI:10.4103/1119-3077.181360  PMID:28256496
Objectives: This study aimed to investigate the preference profiles of various types of diagnostic tools and methods used by private dental practitioners in Ankara for detecting dental caries. Methods: Private dental practitioners, in five districts of Ankara, were provided with questionnaires comprising demographic characteristics, possession of dental imaging systems, and methods used for caries diagnosis. The questionnaires were retrieved after 1-3 visits. Of 722 questionnaires, 371 were returned. Data were analyzed using frequency analysis and Chi-square tests. Results: The completed questionnaires were obtained from 160 women and 168 men, the response rate was 51.4% aged 25-69 years; 28.4% of them were specialists. Most participants possessed a dental radiography (RG) device. Air drying and sharp explorers were the most commonly preferred methods used for caries diagnosis. There was no significant association between using a sharp explorer and sex or being a specialist (P = 0.110, 0.226, respectively). Almost one-third of the dentists with an experience of <11 years, never used an RG device to detect occlusal caries (P = 0.003). Only three participants reported the use of DIAGNOdent, while two participants used fiber-optic transillumination (FOTI). Conclusions: It was observed that visual-tactile examination using sharp explorer accompanied with radiographs were among the main instruments used for detecting carious lesions. Usage of magnification tools, FOTI, and DIAGNOdent were low.
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CASE REPORTS Top

A retroperitoneal extra-renal wilms’ tumour: A case report p. 388
S Wabada, AS Abubakar, AI Adamu, A Kabir, LB Gana
DOI:10.4103/1119-3077.201427  PMID:28256497
Wilms’ tumour originates predominantly in the renal tissue; in rare cases it can also arise from extra-renal sites accounting for 0.5-1% of cases of Wilms’ tumours seen. A diagnosis of extra-renal Wilms’ cannot be easily established with clinical and radiological features except when the histological facts are provided. Wilms’ tumours arising from extra-renal sites may not be different in clinical features, protocol of treatment and outcome from a typical intra renal Wilms’ tumour. A 2-year-old boy presented with an asymptomatic abdominal swelling for 3 months. Abdominal ultrasound and CT scans revealed an extra-renal mass. Intravenous urogram (IVU) showed prompt excretion bilaterally. Post excision histology of the tumour confirmed a Wilms’ tumour.
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Iliacus abscess with radiculopathy mimicking herniated nucleus pulposus: Additional diagnostic value of magnetic resonance imaging p. 392
DH Kim, SH Woo, WJ Lee
DOI:10.4103/1119-3077.201433  PMID:28256498
An iliacus abscess is an extremely rare cause of low back pain. With an iliacus abscess, the classical signs seen with a psoas abscess are frequently absent. Therefore, a timely diagnosis at the initial visit is difficult and inadequate treatment usually results in high mortality. Here, we report the case of 19-year-old man who presented with acute low back pain with radiculopathy and was ultimately diagnosed with an iliacus muscle abscess.
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Portal venous thrombosis developing after torsion of a wandering spleen p. 394
Ö Yilmaz, R Kiziltan, N Almali, A Aras
DOI:10.4103/1119-3077.201431  PMID:28256499
Torsion of a wandering spleen is a rare disease. The symptoms and signs of this condition are only present when the splenic pedicle torts. The etiological factors are the congenital absence of the ligaments that hold the spleen in its normal anatomic position, or the relaxation of these ligaments resulting from conditions like trauma and abdominal surgery. We aimed to present a rare case with torsion of wandering spleen that consequently developed thrombosis of portal vein and its branches, taking into consideration the relevant literature.
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LETTER TO THE EDITOR Top

Effectiveness of microcurrent therapy on sacral pressure ulcer: Our first experience p. 397
A Ünal, Ç Gülsen, F Altuğ
DOI:10.4103/1119-3077.201439  PMID:28256500
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