Background: IMA is a novel marker to consider in ischemic conditions. The initial stages of pregnancy represent a physiological ischemic status. IMA levels may be changed when there is suspicion of early pregnancy complications because of increased oxidative stress. Aim: We aimed to determine and compare IMA values in cases of ectopic and healthy pregnancies as well as early pregnancy loss. Methods: This prospective case control study population (n = 91) consisted of early pregnancy loss (n = 28), ectopic pregnancy (n = 28), and an intracavitary early healthy pregnancy (n = 35). The serum IMA levels were compared in these groups. Results: Demographic parameters were similar and there was no significant difference between the three groups in terms of serum IMA concentrations. Conclusion: We suggested that IMA cannot be used clinically for the diagnosis and follow up of early pregnancy complications during the first five to six gestational weeks.

Background: Shisha is a form of smoked tobacco product. Medical trainees are potential stakeholders in providing accurate information about shisha and discouraging its use. However, few studies have targeted medical trainees to provide much-needed information for policymaking and planning of programs. Aim: To determine the prevalence and predictors of shisha use among medical and dental students in Ibadan, Nigeria. Subjects and Methods: A cross-sectional study was conducted among medical and dental students (n = 252) of the University of Ibadan, selected using the stratified random sampling technique. The Global Health Profession Students Survey (GHPSS) questionnaire was used to obtain information about socio-demographics, shisha and other tobacco use, and knowledge and attitude towards shisha use. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Continuous data were presented using mean and standard deviation, whereas categorical variables were reported as proportions. The association between the outcome variable (shisha use) and independent variables (sociodemographic characteristics, having friends who use shisha) was measured using Pearson's Chi-square test, and factors significant (P < 0.05) were entered into the multivariable logistic regression model. Result: The mean age (± SD) was 21.7 (± 3.1) years. Over half [136 (54%)] were males, and most [199 (79%)] were medical students. About 28 (11%) were not aware of shisha, whereas 22 (8.7%) reported they had ever used shisha. The mean knowledge score was 5.6 ± 4.7, and 76 (33.9%) supported shisha use. Positive predictors of shisha use included the male gender [OR: 6.4 (95% CI: 1.76–23.10)] and having a friend who uses shisha [OR: 28.2 (95% CI: 5.49–144.23)]. Conclusion: The prevalence of shisha use among medical and dental students in Ibadan is unacceptably high, although low compared to other countries in similar resource settings. Surprisingly, the students had poor knowledge about shisha, and over a third supported its use, especially males who were more prone to use it. There is a need to design targeted health promotion and education for the students, especially males.

Background: Family planning deficiencies are responsible for high maternal, newborn, and child mortality in Nigeria, and more than half of all death among adult female is linked to maternal death. Aim: To ascertain the predictors of good knowledge, positive attitudes, and ever practice family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria. Subjects and Methods: A cross-sectional research was carried out among public secondary school teachers aged between 18 and 60 years in Enugu East Senatorial District, Nigeria, using probability proportional to size sampling and systematic random sampling from a selection of 1,000 participants. Factors considered included sources of information on family planning, partner involvement, history of family planning methods, and healthcare facilities. Bivariate and multivariable logistic regression analysis was employed to establish the relationship. An odds ratio of 95% confidence interval (CI) was estimated to ascertain the level of significance. Result: A majority (65.9%) of respondents had a good knowledge of family planning, more than half had positive attitudes (52.7%), and most of them had ever practice family planning (55.0%). Television (AOR = 2.17; 95% CI 1.54-3.06) and social media (AOR = 1.89; 95% CI 1.29-2.78) were effective sources of information to establish significant predictors of good knowledge on family planning. Healthcare (AOR = 0.68; 95% CI 0.51-0.92) and partner discussion (AOR = 3.19; 95% CI 1.94–5.27) were also significant determinants of positive attitudes towards family planning. Cost of obtaining family planning methods (AOR = 0.003; 95% CI 0.001-0.013) and proximity of family planning facilities (AOR = 0.04; 95% CI 0.02-0.10) were notable predictors of ever practice family planning. Conclusion: The level of knowledge, attitudes, and ever practiced family planning among teachers are moderate and a significant number of predictors were identified. Effective awareness is recommended and making use of television as a channel to increase levels of knowledge will hopefully encourage utilization of family planning among teachers.

Background: Zinc is particularly involved in cellular growth, neurodevelopment, and immune function, which is critical for child survival. To reduce neonatal mortality in developing countries, cost-effective and evidence-based interventions that can enhance growth, development, and immunity, need to be considered. Determining the zinc levels of neonates and how it relates to both gestational age is therefore imperative. Subjects and Methods: A descriptive cross-sectional study was carried out at the University of Nigeria Teaching Hospital, aimed at determining the umbilical cord serum zinc levels among neonates and their relationship with their gestational age. Two hundred and seventy-five neonates of gestational ages 28 to 42 weeks were enrolled in the study. Serum zinc levels were determined using the flame atomic absorption spectrophotometer (AAS model no. FS 240 AA.USA, Agilent Technology Ltd.). Results: Among the 275 neonates, there were 27 (9.82%), 28 (10.18%), and 220 (80%) preterms, moderate-to-late preterms, and term neonates, respectively. The mean serum zinc level of all neonates was 87 ± 16.07 μg/dL and within the normal limit of serum zinc. Their mean serum zinc level increased with increasing gestational age (F = 90.424, P < 0.001). Very preterm and moderate-to-late preterm neonates had mean serum zinc levels of 65.13 μg/dL ± 6.15 and 69.85 μg/dL ± 9.63 μg/dL, respectively. Conclusion: This study revealed that though the overall mean serum zinc of neonates was normal, preterms (especially those of lower gestational ages) were zinc deficient. Routine zinc supplementation at birth should be considered in preterm neonates to reduce the untoward effects of zinc deficiency.

Background: The perioperative mortality rate (POMR) has been recognized as a useful indicator to measure surgical safety at an institutional or national level. The POMR can thus be used as a tool to identify procedures that carry the highest mortality rates and provide hindsight based on past surgical experiences. Aim: To document the pattern of perioperative mortality and the factors that influence it at district hospitals in southeast Nigeria. Patients and Methods: This was a retrospective study of cases of perioperative mortality at district hospitals in southeast Nigeria between January 2014 to December 2018. All perioperative mortalities from surgical admissions in both elective and emergency set-ups were included. During analysis, we computed P values for categorical variables using Chi-square and Fisher's exact test in accordance with the size of the dataset. Furthermore, we determined the association between some selected clinical variables and mortality using logistic regression analyses. Results: During the period under review, 254 perioperative deaths occurred from 2,369 surgical operations, giving a POMR of 10.7%. Of the 254 deaths, there were 180 (70.9%) males and 74 (29.1%) females. Nearly one-third (31.2%) were farmers and 64.2% of the deaths occurred in those 50 years and below. Delayed presentation was two-pronged: delay before presentation and in-hospital delay. The POMR was the highest among general surgery emergencies and least among those with plastic surgery conditions. The observed factors associated with mortality were time of presentation (early or late), type of surgery (emergency or elective), category of surgery (general surgery or others), American Society of Anesthesiologists (ASA) score (high or low), place of admission after surgery (intensive care unit or general ward), level of training of doctors who performed the surgery (specialist or general duty doctor) (P < 0.05). Conclusion: The POMR was higher in male patients and in those with general surgery emergencies compared to other conditions. Delayed presentation, high ASA scores, and operations performed under emergency set-ups were associated with elevated POMRs.

Background: Nurses were affected by this pandemic more than any other healthcare professionals because they were working on the frontline continuously. Aims: The current study explored how nurses who care for patients with COVID-19 assess this process which they experienced, how they coped with the process, and their psychological experiences. The study was conducted by reaching out to the nurses working at pandemic clinics using the snowball sampling method. A total of 40 nurses were interviewed using telephone. The study employed a descriptive qualitative approach. The data were obtained through telephonic interviews that were performed by the researcher using interview forms. Materials and Methods: The interview notes were analyzed using the content analysis method according to Colaizzi's phenomenological method. Results: As a result of the content analysis, four themes emerged with the following headings: Initial reactions, factors that made an adaptation to the period of pandemic challenging, factors that facilitated the adaptation, and what the period of pandemic taught. Conclusions: It is suggested for nurses that their rotation should be planned effectively, and their social support should be enhanced. They should be provided with adequate personal protective equipment and human resource planning should be improved until the end of the COVID-19 pandemic.

Background: Social disadvantage has an influence on the health of individuals. In developed countries, the prevalence, pattern of social disadvantage, and the outcome of admissions in socially disadvantaged children are under-studied. Aim: To determine the prevalence of social disadvantage, pattern of diseases, and illness outcomes among socially disadvantaged children. Patients and Methods: This was a prospective hospital-based study involving 400 patients who presented at the pediatric emergency unit (PEU) of a tertiary hospital in Southwest Nigeria. Information on socio-demography and history of illness was obtained from consecutive children using a proforma. The data was analyzed using SPSS version 20. Results: The 400 participants comprised 276 male and 124 female giving a ratio of 2.2:1. Their age range was 1–14 years; the mean ± SD age was 4.6 ± 2.3. Three hundred (75%) of the children were socially disadvantaged. The social factors associated with social disadvantage were low income, unemployment of mothers, polygamous setting, single parenting, rural residence, and low registration for health insurance. There was a significant association between social disadvantage and the development of malaria (P = 0.03), pneumonia (P = 0.01), septicemia (P = 0.03), diarrhea diseases (P = 0.04), neonatal jaundice (P = 0.04), meningitis (P = 0.04), and protein-energy malnutrition (P = 0.003). Death was significantly worse among the children who are socially disadvantaged (P = 0.0001). Conclusion: Many children admitted to the PEU in Osogbo are socially disadvantaged. Children of low-income parents, unemployed mother, single parent, residents of rural places, and those without health insurance are more vulnerable to developing infectious disease as well as neonatal jaundice and protein-energy malnutrition. Socially disadvantage increases the risk of poor illness outcome (death).

Background: COVID-19 is a potentially fatal disease that was announced as a global pandemic at the beginning of the year 2020. Aim: The purpose of our cross-sectional study was to evaluate the infection-control knowledge, attitude, practice, and risk perception of occupational exposure to COVID-19 among multinational dentists. Patients and Methods: A self-designed, 33-item, English questionnaire was created and distributed through social media and digital communication platforms. The questionnaire covered the demographic data, knowledge and perception of the occupational risk of the COVID-19 infections, and compared some infection control measures taken before and after this global pandemic. The results were analyzed, and four scores were used to assess the aforementioned parameters. Results: A total of 300 multinational dentists answered our survey, with the majority being females (59%) and aging from 25 to 44 years old (68%). We found that a statistically significant relationship exists between attitude and nationality, country of practice, medical condition, and the practicing specialty (P < 0.05). In addition, risk perception had a statistically significant correlation with nationality, smoking habits, education level, and specialty (P < 0.05). Furthermore, there was a statistically significant correlation between the practice score and the gender, age, smoking habits, education level, nature of the practice (private or governmental), and academia affiliation (P < 0.05). Conclusions: The study sample had good compliance with the instructions and guidelines of the World Health Organization (WHO) and the Centre for Disease Control (CDC), with most of them improving their infection control precautions after the virus's emergence according to the said guidelines. Furthermore, our participants were fearful of the COVID-19 virus and the fact of being potential transmitters. Despite saying that, the significant majority of them reported being confident in treating COVID-19–positive patients.

Background: Cancers are a disease of growing public health importance in Africa, but cancer research capacity in the region is underdeveloped. The quest to foster and promote locally conceptualized and conducted oncology research in Africa have informed the African Research Group for Oncology's (ARGO) research capacity-building efforts in Nigeria. Aim: To evaluate the effectiveness of oncology research capacity-building initiatives among Nigerian senior trainees and junior faculty physicians. Subjects and Methods: Panel study design was employed to study Nigerian senior trainees and junior faculty physicians who participated in two research capacity-building symposia. Data were collected pre-and immediate post-symposia, and 3-month post-first symposium. Changes in knowledge were assessed using the Chi-square test and confidence levels using the Wilcoxon signed rank test. A P value of <0.05 was considered statistically significant. Results: In the first symposium, the participants' pass rate in the knowledge-based questions improved from 9.8% to 46.7% to 81.5% at the baseline, immediate post-symposium, and 3-month post-symposium, respectively (P < 0.001). Likewise, the participants' confidence level in carrying out certain research-related activities increased after the second symposium (P < 0.001). Conclusion: The study concludes that building capacity for oncology research in low- and middle-income countries is possible with focused symposia and educational programs.

Background: Tinnitus is a common auditory complaint among individuals characterized by ringing, buzzing, hissing, chirping, whistling, or other sounds in the ear. Following a low-fat/low-cholesterol diet can help reduce the blood cholesterol and triglyceride levels, which aids improvement in tinnitus symptoms. High cholesterol and triglyceride levels in the bloodstream play a significant role in the development of tinnitus, hearing loss, and vertigo. Aim: This paper aims to test the association between hyperlipidemia and tinnitus among outpatients in King Khalid University (KKU) ENT clinic. Patients and Methods: A retrospective review of the medical records of patients who attended the ENT clinic at KKU was performed. An otological examination including pure tone audiometry, personal habits, and lipid profile was conducted. Patients were contacted by phone if there were any missing data. Results: The study included 300 patients who were treated in the outpatient clinic during the study period. About 80% of the patients were of age >45 years and 60.3% were males. Half of the cases (150 cases) had tinnitus and 13% had hyperlipidemia. Patients with high lipid profile recorded doubled risk for tinnitus (P < 0.05). Other risk factors found to be significantly associated with tinnitus include vertigo, young age, and wearing an earpiece. Conclusions: In conclusion, there was a significant association between hyperlipidemia and the incidence of tinnitus even after adjusting for all other risk factors. More large-scale researches are needed to assess in detail the association between different lipid components such as low-density lipoprotein, high-density lipoprotein, triglycerides, and tinnitus epidemiology.

Background: There is evidence that placenta site location might be associated with some adverse maternal and fetal outcomes, however, there is lack of information on this observation in Nigeria and many other developing countries where routine ultrasound is performed as part of antenatal care. Aim: To determine the relationship between placenta location on ultrasonography and adverse pregnancy outcomes among a cohort of women with singleton pregnancies. Materials and Methods: In a longitudinal study among pregnant women from the antenatal clinic of a tertiary health institution in Nigeria. The demographic, clinical parameters, the ultrasonographic placenta location, and pregnancy outcomes of women followed until delivery, or pregnancy termination were documented and analyzed; P > 0.05 was statistically significant. Result: One hundred and fifty singleton pregnant women (43 high risk and 107 normal gestations) were studied. The placenta location was anterior in 72 (48%), posterior in 59 (39.3%), fundal in 10 (6.7%) and lateral in 9 (6.0%) cases. Pregnancies with fundal placenta 8/10 (80%) had more preterm birth compared to 23/72 (31.9%), 11/59 (18.6%) and 2/9 (22.2%) that had anterior, posterior and lateral placenta (P = 0.001) respectively. The mean gestational age (GA) at delivery in those with fundal (34.0 ± 3.9 weeks), anterior (37.0 ± 2.7 weeks), lateral (37.7 ± 1.8 weeks), and posterior placenta (37.7 ± 1.8 weeks) was significantly different P < 0.001. In addition, there was a significant difference in the mean birth weight at delivery in women with fundal (2.09 ± 0.99 kg), anterior (2.84 ± 0.7 kg), posterior (3.0 ± 0.65 kg) and lateral placenta (3.0 ± 0.65 kg) respectively P = 0.002. Conclusion: This study showed that placenta location by ultrasound may be associated with some adverse pregnancy outcomes. The placenta located in the fundus was more likely to be associated with preterm birth and prematurity.

Aim: This article aims to study the clinical outcomes in patients with chronic subdural hematoma (CSDH) who underwent burr hole drainage or craniotomy. Patients and Methods: The length of hospitalization, Glasgow outcome scales (GOS) of patients undergoing burr-hole drainage or craniotomy, were evaluated and compared statistically. In this study, we also evaluated the relationship by receiver operating characteristic (ROC) analysis. Results: The sex and age distribution and specific clinical parameters of the patients were investigated. In this study, we provide the evidence of the GOS and length of hospitalization findings of the patients and the superiority of burr hole drainage over craniotomy. Conclusions: Chronic subdural hematoma responds better to burr hole drainage with shorter hospitalization and improved Glasgow score.

Background: Affinity of coronavirus disease to the central nervous system is not well known. Aim: We aimed to share the data of COVID-19 patients with neurological complaints in a pandemia hospital. Material and Method: Consultation results requested from the neurology clinic of Konya Meram State Hospital were retrospectively examined. PCR test positive patients, PCR negative patients with positive clinical, laboratory and radiological findings with COVID-19 were evaluated. Age, gender, history of neurological diseases, and neurological symptoms were recorded. Results: The reason for consultation was acute neurological symptom in 96 (84.2%) patients, counseling for treatment in chronic disease in 15 (13.2%) patients, and worsening in chronic disease in 3 (2.6%) patients. As neurological disorders, 22 (19.3%) had a history of previous stroke, 10 (8.8%) had dementia, 4 (3.5%) had epilepsy, 4 (3.5%) had Parkinson's disease, 3 (2.6%) had multiple sclerosis, 2 (1.8%) had myasthenia graves, and 1 (0.9%) had restless legs syndrome respectively. The most common reason for requesting consultation was changes in consciousness (56.1%). Of the 114 patients who requested neurology consultation, 65 (57%) were discharged, 49 (43%) were died. Conclusion: The change in consciousness was the reason in more than half of the patients who requested neurology consultation during COVID-19 follow-up. Impaired consciousness in a patient with COVID-19 may indicate a poor prognosis. If the studies planned in the near future can shed light on the cause of the unconsciousness developing in COVID-19, it will be promising in terms of treatment plans to reduce mortality.

Background: Integrity of outer retinal bands among multiple sclerosis (MS) subtypes remains unclear, however alterations of thickness in retinal layers is well described. Aim: The objective of the study was to determine the alterations in the thickness of the inner and outer layers of the retina and the findings in both layers detected by optical coherence tomography (OCT) among patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS). Patients and Methods: A total of 132 eyes from 66 patients with multiple sclerosis (MS) (70 eyes from 35 patients with RRMS and 62 eyes from 31 patients with SPMS) and 72 eyes from 36 healthy controls were included in the study. The external structures of the retina, including the outer limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ), were examined using OCT in RRMS, SPMS, and healthy control groups. The correlation of neurological disability expressed by the Expanded Disability Study Scale (EDSS) score, best-corrected visual acuity, and duration of disease among OCT parameters was also analyzed. Results: In eyes, with no history of previous optic neuritis (ON), the macular nerve fiber layer, the internal plexiform layer of ganglion cells (GCIPL), and the total thickness of the retinal layer were thinner in the SPMS group than in the RRMS group (P < 0.05, in each comparison). EZ was more vulnerable among the three hyperreflective external retinal zones in the retina of patients with SPMS than in patients with RRMS (P = 0.016). Conclusions: Alterations in retinal thickness in MS are not limited to the inner layers of the retina and also occur in the outer structures of the retina.

Background: Skin disorders among primary school children are common in many countries, with a variable spectrum. They can constitute major health problems, resulting in considerable discomfort, parental anxiety, and embarrassment to the child. Aim: To determine the prevalence and pattern of skin diseases among primary school children in the Umuahia South local government area. Subjects and Methods: This was a descriptive cross-sectional study carried out over a 4-month period from December 2016 to March 2017 among school children consecutively recruited from their various primary schools. Result: A total of 1560 children aged 5 to 15 years with a mean age of 8.74 ± 2.079 years were studied. The overall prevalence of skin diseases was 40.2%. The prevalence in public schools was 46.0%, whereas the prevalence in private schools was 33.2% (P < 0.001). Skin eruptions and itchy skin were the most common presentations, whereas tinea capitis, pityriasis versicolor, and scabies were the most common skin diseases noted among the school children. Conclusion: The prevalence of skin diseases in the population studied is high, especially in public schools. The most common manifestation of skin disease is rash, and the most common type of skin disease is tinea capitis. It is recommended that standard hygienic practices should be maintained by primary school children and their parents/caregivers to prevent skin diseases.

Background: Bone reduction and shelf preparation is a common procedure to establish a new alveolar plane before implant surgery, which might effect the primary stability. Aim: Primary stability was questioned in terms of bone reduction and shelf preparation. The suitability of immediate loading was compared between the implants placed on crests, which underwent alveoloplasty, and the implants placed on a naturally healed alveolar bone. Patients and Methods: We designed and implemented a retrospective cohort study. Twenty patients (mean age 49.2 years) were treated with 160 dental implants. The primary predictor variable was extraction and bone reduction. The secondary predictor variables were bone density and the implant surface. The outcome variables were resonance frequency analysis (RFA) and insertion torque (IT) values. Results: There was no statistically significant difference between groups regarding RFA and IT (P > 0,05). Interactions of surface area with the RFA and IT in both groups were not statistically significant; however, bone density presented a statistically significant effect on outcome variables for both groups. Conclusion: IT and RFA are not influenced by bone reduction, shelf preparation, or the implant surface. Primary stability is mostly affected by bone density in the immediate load of 4 implants to support a full-arch prosthesis.

Background: The management of acute respiratory failure in COVID-19 patients and the role and limitations of high-flow nasal oxygen therapy (HFNOT) remain unclear. Aim: This study aimed to investigate the effect of HFNOT, identify the characteristics of patients who will benefit from therapy, and determine monitoring strategies to decide on endotracheal intubation for patients with COVID-19. Patients and Methods: We conducted a prospective observational study of COVID-19 patients who were admitted to the intensive care unit (ICU) and required HFNOT for at least 2 days between 20 March 2020 and 20 June 2020. The exclusion criteria were a severe respiratory failure, reduced levels of consciousness, combination with other noninvasive ventilation strategies, and exhaustion. The patients were followed up until ICU discharge. The primary outcome was the proportion of patients with COVID-19 who were successfully weaned from HFNOT, whereas failure comprised intubation or death on HFNOT. Results: Thirty-five subjects (24 males, mean-age: 61.62, standard deviation: 14.9 yr.) were included in the study. A total of 20/35 (57.1%) subjects survived to discharge. C-reactive-protein (CRP) and interleukin-6 (IL-6) levels were significantly increased in the treatment failure group (CRP; effect size (r):0.35, P: 0.037, IL-6; r: 0.37, P: 0.03). Although there was a difference between repeated measures of partial-pressure-of-oxygen/fraction-of-inspired-oxygen (PaO₂/FiO₂:P/F) rates (partial-eta-squared (η_p²):0.79, P < 0.001), no difference was found between carbon dioxide levels (η_p²:0.29, p: 0.44). There was also no difference between ROX (ratio-of-oxygen-saturation/FiO₂ to respiratory-rate) rates (Kendall's W: 0.33 P = 0.310). Conclusion: In COVID-19 patients with mild-to-moderate dyspnea and hypoxemia who are nonresponsive to conventional-oxygen-therapies, the initial approach may involve the use of HFNOT. In this study, patient monitoring could be performed with ROX and P/F ratios, and the effectiveness of the treatment could be decided by looking at these rates in the second hour. Prolongation of the period and awake prone positioning did not improve the outcome.

Background: Exenatide is a glucagon-like peptide-1 (GLP-1) analogs. The effects of GLP-1 analogs on myocardial function are controversial. Aims: The purpose of this study is to compare the effects of exenatide and insulin glargine on subclinical right and left ventricular dysfunction. Methods and Material: In this study, 27 patients with type 2 diabetes were randomized into exenatide and insulin glargine treatment groups. The patients were monitored for six months by conventional echocardiography (ECHO) and 2D-speckle-tracking echocardiography (2D-STE) to evaluate right and left ventricular functions. Results: ECHO parameters did not change significantly pre- and post-treatment, except for the tricuspid annular plane systolic excursion (TAPSE) values. Post-treatment TAPSE values significantly increased in both groups compared to pre-treatment values. In the insulin group, values for 2D-STE parameters of the left ventricular global longitudinal strain (LVGLS) based on apical long-axis (ALA) images increased significantly (p: 0.047) compared to pre-treatment values; however, apical 4-chamber (A4C), apical 2-chamber (A2C), LVGLS, and right ventricular global longitudinal strain (RVGLS) values did not change. In the exenatide group, LVGLS based on A4C values improved (p: 0.048), while ALA, A2C, and LVGLS values did not change. Moreover, the RVGLS values improved significantly after exenatide treatment (p: 0.002). Based on 2D-STE parameters the two treatments did not differ statistically in either pre- or post-treatment periods. Conclusions: Glp-1 treatment can improve left ventricular regional and right ventricular global subclinical dysfunction. Therefore, early GLP-1 treatment may be recommended in diabetic patients with a high risk of cardiac dysfunction.

Background: Colorectal cancer (CRC) is the second most frequently diagnosed cancer in women and the third in men. Anaemia is a common condition in patients with CRC. Aim: In this study, we aimed to retrospectively analyse the relationship between preoperative anaemia (POA) and postoperative complications in patients with colorectal cancer (CRC) that underwent elective surgery. Patients and Methods: The data of patients who underwent elective curative surgery for CRC between January 2015 and December 2020 and had pathologically-proven cancer were evaluated retrospectively. We examined the effect of demographic characteristics of patients, preoperative haemoglobin, cancer localization (colon/rectum), American Society of Anaesthesiologist (ASA) classification, preoperative co-morbidity, surgical method (laparoscopic/open), stoma status, tumor stage, presence of preoperative anaemia on surgical site infection, pulmonary complications, renal complications, anastomotic leaks, and need for intensive care and re-operation in the postoperative period. Results: Of the 352 patients who underwent curative resection for CRC, 177 (50.3%) were diagnosed with POA. The median haemoglobin value was 10.7 g/dl in POA patients while it was 13.6 g/dl in the non-POA group. Regarding the localization of tumor, the patients with tumors on the right colon were more statistically significant in terms of POA (p < 0.05). Patients with POA had a higher rate of hypertension and coronary artery disease compared to patients without POA (p < 0.05). In patients with POA, surgical site infection and need for intensive care were statistically significant in the postoperative period compared to patients without POA (p < 0.05, P < 0.01, respectively). However, there was no significant difference between the two groups regarding pulmonary complications, renal complications, anastomotic leaks, and need for re-operation in the postoperative period. Conclusion: We believe that POA should be corrected prior to surgery to reduce not only the need for intensive care but also surgical site infection in patients undergoing elective curative surgery for CRC.

Background: Platelet-rich fibrin (PRF) are widely used in impacted lower third molar (IL3M) 7 surgery and its effect on postoperative edema was generally analysed with linear methods. Aim: To analyze the effectiveness of platelet-rich fibrin (PRF) applied to the socket after tooth extraction in impacted lower third molar (IL3M) surgery performed with piezosurgery in the reduction of edema observed in the postoperative period, together with conventional (linear) and three-dimensional (volumetric) measurement methods. Materials and Method: The study was designed as a prospective randomized split-mouth study and was conducted on 30 patients with bilateral IL3M teeth. Extraction of the patients' IL3M teeth was performed in the same session with the help of piezosurgery. After the extraction, PRF was randomly applied to one socket, but it was not applied to the other socket, which formed the control group. On the first, second, and seventh days after the procedure, volume was measured using 3dMD, and the distance between the topographic guide points was measured using a flexible ruler. The results were analyzed statistically. Alveolar osteitis (AO) presence was also recorded. Results: A significant improvement in edema was observed in both groups, but no significant difference was found between the groups (P > 0.05). A moderate correlation was found between the two methods of measuring edema. AO was not seen in any patient. Conclusions: Although PRF reduces edema after IL3M tooth extraction and 3dMD is effective in its evaluation, it has no statistical advantage over classical methods.

Background: Globally, a dramatic increase in the use of television and digital media has been observed among children and adolescents in recent times. The possible health-related effects of frequent and prolonged screen media viewing on these children and adolescents have triggered many concerns among researchers. Aim: The study is aimed to determine the screen media viewing practices and caregivers' level of knowledge about the health-related effects of prolonged screen viewing time on their children. This was a descriptive cross-sectional study among caregiver/child and adolescent dyads on outpatient clinic visits. Subjects and Methods: Respondents (caregivers/children's pairs) were consecutively recruited, and data was obtained using an unambiguous pre-tested semi-structured questionnaire comprising four domains: socio demographic characteristics; screen media viewing characteristics, perception of the health related effects of prolonged viewing time, and measures to limit prolonged screen viewing time in children. Descriptive and inferential statistics were done using Statistical Package for Social Sciences (SPSS) version 22.0 at a level of statistical significance P < 0.05. Results: Of the 205 respondents studied, the majority (67.8%, fathers and 76.1%, mothers) had tertiary education. The daily mean time spent by children watching television/screen media was 2 (± 1.58) hours. Up to 89.3% of the caregivers established good standards for healthy screen-viewing in their homes. However, 52.7% of them had poor knowledge of the health-related problems of increased viewing time. Socio-economic class (P = 0.002) and knowledge level of the parents (P = 0.000) were significant predictors limiting children's screen-viewing time. Conclusion: Increasing screen media viewing is common among the children studied. The majority of the caregivers had poor knowledge of health-related effects of prolonged viewing time despite high educational attainment. There is a need to enlighten caregivers on the possible health effects of excess screen media viewing so as to enable them to institute stringent measures to limit the attendant health consequences on the children.

Background: Weight in individuals can affect the saliva structure, which has an essential role in caries prevention. Aim: This meta-analysis aimed to compare individuals with obesity (OB)/overweight (OW) and normal weight (NW) in terms of salivary flow rate (SFR), salivary pH (SpH), salivary buffer capacity (SBC). Materials and Methods: After electronic databases (Web of Science, PubMed, Scopus, Cochrane Library, and Open Grey databases) were screened, studies were selected depending on inclusion criteria. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the risk of bias in individual studies. Mean differences (MD) were used to measure the effect estimates in the comparisons of OB vs NW, OW vs NW, and OB+OW vs NW. Additional analyzes such as subgroup, moderator, sensitivity, and grade were also performed. Results: 24 studies and 2072 participants (SFR: 748 OB, 896 NW, SpH: 137 OB, 166 NW, SBC: 62 OB, 63 NW) were included in the quantitative synthesis. Significantly lower SFR was found in the group with OB compared to NW when saliva was stimulated (MD = -0.21, 95% CI [-0.30, -0.12], P < 0.001), but no significance was obtained when saliva was unstimulated (MD = -0.02, 95% CI [-0.11, 0.06], P = 0.55). No significant difference was found in the group with OB compared to NW in SpH (MD = -0.07, 95% CI [-0.26,0.12], P = 0.48) and SBC (MD = -1.10, 95% CI [-2.29,0.09], P = 0.07). Conclusions: SFR significantly decreases in individuals with OB, notably when saliva is stimulated. Besides, the decrease in SFR is much more prominent in adolescence and adulthood than in childhood. Furthermore, the increase in the severity of OB causes a much greater decrease in SFR. However, regarding SpH and SBC, no significant association exists.

Background: The optimal management of intra-articular calcaneal fractures is still controversial. Open reduction and internal fixation are always associated with serious complications. Aim: Various alternative methods have been used with variable effects. This retrospective study aimed to analyze the clinical efficacy and safety of a new “below-the-ankle” Ilizarov frame in patients with calcaneal fractures caused by high-energy trauma. Patients and Methods: We retrospectively explored ten patients with calcaneal fractures, of which four, five, and one were Sanders type II, III, and IV, respectively. All fractures were caused by high-energy trauma and were followed up for an average period of 21 months (range: 9–29 months). Clinical outcomes were primarily assessed by radiological criteria, functional scores of the foot and ankle, rate of complications, and ankle range of movement. Results: The Ilizarov frame was removed after an average period of 12 weeks (range: 11–15 weeks). Only two patients developed pin-tract infections, and none developed osteomyelitis, deep infections, neurovascular injury, malunion, and ankle arthrodesis. Based on the radiological assessment of the reduction of the subtalar joint and fracture fragments, all patients had excellent restored joint structure, with eight and two patients having good-to-excellent and fair ankle scores, respectively. The ranges of plantarflexion and dorsiflexion were 25°–43° and 8°–22°, respectively. Conclusion: The Ilizarov frame could be safe and effective for calcaneal fractures caused by high-energy trauma. This treatment protocol provides an effective approach to treat severe calcaneal fractures caused by high-energy events; however, long-term outcomes are still unknown.

Background and Aims: This experimental study was designed to test the hypothesis that ondansetron, a selective 5-HT3 receptor antagonist, would decrease the duration of motor, sensory, and proprioception blockade in a dose-dependent fashion in a bupivacaine-induced sciatic nerve blockade. Materials and Methods: Forty-nine male Wistar Albino rats who underwent unilateral sciatic nerve block were divided into seven groups with an equal number in each group. Group B: only perineural block (PB), Group BO200: PB and perineural 200 μg ondansetron, Group BO400: PB and perineural 400 μg ondansetron, Group BO800: PB and perineural 800 μg ondansetron, Group BO800IP: PB and intraperitoneal 800 μg ondansetron, Group O800: only perineural 800 μg ondansetron, Group S: sham-operated. The rats' motor, sensory, and proprioception functions were evaluated by a blinded investigator every 10 min until they returned to normal function. The recovery times of the motor, sensory, and proprioception functions were recorded and compared. All sciatic nerves were removed and examined by electron microscopy for neurotoxic signs. Results: In which sciatic nerve block was formed with bupivacaine, the duration of the motor, sensory, and proprioception functions blockade was decreased, and the duration to return to normal functions was significantly shortened at Group BO800 (p < 0.05). According to electron microscopy results, perineural 200 μg, 400 μg, and 800 μg ondansetron were not neurotoxic. Conclusion: This is the first study showing that perineural ondansetron administration (800 μg dose) reverses the effect of the local anesthetics and shortens the duration of the motor, sensory, and proprioception functions blockade.

Background and Aim: Headless cannulated compression screw is often used in scaphoid fracture and nonunion surgery. In the volar and dorsal surgical approach, when adequate fluoroscopic imaging is not performed, the screw may protrude beyond the scaphoid bone and penetrate into the joint. When the length of the screw is too long, and it is noticed intraoperatively, it is replaced with a shorter screw. However, there is no clear consensus in the literature about the way to be followed when screw penetration is noticed in the postoperative period. Materials and Methods: The cases in which cannulated screw penetrated the radioscaphoid, scapholunate, and scaphotrapeziotrapezoid joint on postoperative radiographs were included in this study. Sixteen patients (13 men and 3 women) were included. The mean postoperative follow up time was 35.1 months. There was scaphotrapeziotrapezoid joint penetration in seven cases, scapholunate joint penetration in two cases, and radioscaphoid joint penetration in seven cases. Results: Osteoarthritis developed in the scapholunate joint in two cases and in the radioscaphoid joint in two cases. Early revision surgery or waiting for the fracture to heal and removing the screw, or not performing secondary surgery are among the options. In this study, mid term radiological results of screws penetrating radioscaphoid, scapholunate, and scaphotrapeziotrapezoid joints were examined. It was observed that it may cause osteoarthritis development in radioscaphoid and scapholunate joints, but it did not cause osteoarthritis development in scaphotrapeziotrapezoid joint. Conclusion: In the early postoperative period, revision surgery is recommended to prevent the development of osteoarthritis of screws penetrating the radioscaphoid and scapholunate joint.

Background and Aim: Vitamin D receptor (VDR) gene polymorphisms have been implicated in the pathogenesis of many diseases, such as periodontitis and diabetes mellitus (DM). The present study aimed to evaluate the distributions of VDR polymorphisms in diabetic individuals with healthy periodontium (DMH), diabetic individuals with periodontitis (DMP), nondiabetic individuals with healthy periodontium (H), and nondiabetic individuals with periodontitis (P). Material and Methods: A total of 200 individuals (DMH = 40, DMP = 60, H = 40, and P = 60) were recruited. All clinical periodontal parameters, demographical, and biochemical variables were recorded. Blood samples were collected, and genomic DNA was isolated by Purelink® Genomic DNA Mini Kit. Genotyping of VDR polymorphisms ApaI, BsmI, FokI, and TaqI were determined by real-time polymerase chain reaction (PCR) using allele-specific probes. Results: The distribution of the BsmI variant showed differences between DMH and H groups (P = 0.034). In addition, carrying the GG genotype (OR = 0.317; 95% CI = 0.126–0.797; P = 0.013) and the G allele (OR = 2.373; 95% CI = 1.203–4.681; P = 0.012) increased the risk of type 2 DM. Moreover, it was determined that the frequency of CC genotype of FokI variant was higher in DMP compared to DMH (P = 0.046). It was determined that having the CC genotype (OR = 2.706; 95% CI = 1.185–6.176; P = 0.017) and the C allele (OR = 1.917; 95% CI = 0.995–3.694; P = 0.049) increased the risk of periodontitis among diabetic individuals. No differences were detected among groups in the genotype and allele distributions of ApaI and TaqI variants (P > 0.05). Conclusions: The present study showed that the BsmI variant was a risk factor for DM among periodontally healthy individuals and the FokI variant for periodontitis among diabetic individuals.

Background/Aim: Early marriage is a preventable public health problem that brings along social and health problems as well. This study was performed to determine the views of adult married women, who live in the villages located in the central district of Bitlis which is situated in the eastern region of Turkey, on early marriage and compare their views with their perception of health. Subjects and Methods: Adult married women, who live in the villages located in the central district of Bitlis which is situated in the eastern region of Turkey, constitute the population of this cross-sectional study. Results: Customs and traditions, helping with household chores or agricultural tasks, and bride price are the main factors in preferring these marriages. It has been determined that age (r = 0.100; P = 0.047) and number of children (r = 0.153; P = 0.002) are positively related with health perception, albeit weakly. The median (score: 49) of women having five or more children is significantly higher than women (score: 45) with children in the range of 0-2. Conclusion: Women living in rural areas have a high rate of early marriage, and traditions and customs determine the decision to marry. Age and number of children were found to be positively correlated with perception of health, though weakly. Increasing the perception of health before and during the initial years of marriage could help in preventing many adverse effects that are caused by early marriage. With the increase in age and number of children, women might seek more health. This can increase women's health perception.

Background: In the developing world, access to pediatric surgery has been associated with sociocultural factors and healthcare funding challenges. Aim: This study aims to evaluate health worker (HW) factors in delayed access to appropriate care for children with surgical problems in South East Nigeria. Subjects and Methods: A cross-sectional analysis of the awareness of children's surgery and ability for appropriate referral among 503 HWs of various cadres in South East Nigeria was carried out using a structured questionnaire. Data was analyzed using IBM SPSS 21. Results: Of 419 (83.3%) respondents, 211 (50.4%) were doctors, 217 (51.8%) were aged 26–35 years, 261 (62.3%) indicated awareness of pediatric surgical conditions, 114 (27.2%) knew of sites to examine on the newborn at birth, and 147 (35.1%) inclined to timely referral to experts. Predictors of early referral include age <35 years, (P = 0.001) and cadre: doctors (P = 0.006). Female HWs (P = 0.013) and doctors (P = 0.008) displayed better knowledge of pediatric surgical cases. Delayed referral was mostly HW-related and included inaccurate diagnosis and wrong assumption of competence. Conditions commonly misdiagnosed were intussusception and posterior urethral valve. Conclusion: Awareness of surgical needs of children is poor among HWs in our setting. To address this and improve access to care, there may be a need to incorporate basic training in common pediatric surgical conditions in the training curriculum for HWs at various levels.

Postpartum hemorrhage is the most important and also preventable cause of maternal morbidity and mortality worldwide. Arteriovenous malformation (AVM) is a rare cause of postpartum hemorrhage. We present a case of arteriovenous malformation, which may be one of the rare but potentially fatal causes of postpartum hemorrhage (PPH). In the case report, on the postpartum 52^nd day, the patient presented to the emergency department with a complaint of vaginal bleeding. Doppler ultrasonography revealed a lesion compatible with the vascular structure, the largest diameter of 28 * 28 mm, in the uterus. The patient was found not eligible for embolization, and a hysterectomy was then indicated. After the hysterectomy, the pathology diagnosis supported the initial clinical and radiological suspicions of AVM. Hysterectomy is the definitive treatment method of AVM and should be considered in patients who are not eligible for embolization. This case is presented to draw the attention of physicians to AVM as a possible cause of secondary PPH.

Traumatic near total amputation of the hand with major vascular injury may lead to loss of the hand with dire consequences to the patient. A prompt attempt at salvaging the hand is key to prevent the untoward consequences. In addition, the awareness of the possibility of salvage in our environment should be spread among health care personnel as well as the need for multispecialty approach to the management. We report 2 patients with near total unilateral amputation of their hands proximal to the wrist who underwent salvage procedures.

Long QT syndrome (LQTS) is a rare disease entity which until recently was not readily recognized as one of the causes of sudden cardiac death in children. It is a syndrome which can be congenital or acquired and is characterized by the prolongation of the QTc interval, the presence of some electrocardiographic abnormalities and other clinical parameters together with suggestive or definitive family history (Schwartz criteria). The index case is a 4-year-old female who initially presented for management on account of post native tonsillectomy hemorrhage with secondary severe anemia and associated sepsis who subsequently developed bradycardia and marked prolongation of the QTc interval on electrocardiogram. Possible factors implicated as a cause of the prolongation of the QTc include severe anemia and anesthetic drugs with a probability of an underlying genetic cause. This case highlights a rare cause of sudden cardiac death in children in our environment with the attendant difficulties in making a genetic diagnosis due to inadequate laboratory facilities.