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   Table of Contents - Current issue
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April 2022
Volume 25 | Issue 4
Page Nos. 379-556

Online since Tuesday, April 19, 2022

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REVIEW ARTICLE  

Maxillary sinusitis caused by retained dental impression material: An unusual case report and literature review Highly accessed article p. 379
M Manchisi, I Bianchi, S Bernardi, G Varvara, V Pinchi
DOI:10.4103/njcp.njcp_1662_21  
Surgical procedures in posterior area of maxillary might cause an oroantral communication and iatrogenic sinusitis. An undetected oroantral communication can cause the penetration of foreign bodies, such as dental impression materials, in the maxillary sinus, thereby contributing to persistent sinusitis. Given the occurrence of a very rare clinical and medicolegal case of persistent and drug-resistant sinusitis due to radiologically undetected fragments of silicone paste for dental impression in the maxillary antrum, a literature review was pursued through sensitive keywords in relevant databases for health sciences. All retrieved articles were considered and data about the kind of impression materials thrusted into the maxillary sinus, the diagnostic issues, the reported range of symptoms, and the occurrence of medicolegal issues were analyzed. The diagnosis resulted to be quite challenging and belatedly especially in case of healed oroantral communication and when the material retained in the maxillary sinus has similar radiodensity compared to the surrounding normal or inflammatory tissues. The case was then discussed in comparison with the reviewed literature for both clinical and medicolegal issues. Hints were provided to professionals to face the challenging diagnosis in similar rare cases and to avoid the possible related litigation.
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ORIGINAL ARTICLES Top

Blood pressure profile, prevalence of hypertension and associated familial factors in school children in Accra, Ghana Highly accessed article p. 386
TJ Afaa, NA H Seneadza, E Ameyaw, OP Rodrigues
DOI:10.4103/njcp.njcp_1832_21  
Background: Essential hypertension, which is hypertension without a known cause, runs in families. Children from families with hypertension are likely to have a higher blood pressure than children from normotensive families. Aim: The aim of this study was to find the prevalence of hypertension and the associated family risk factors for hypertension in the school children. Patients and Methods: This prevalence study was conducted in six first-cycle schools in Accra, Ghana. School children between the ages of five to fourteen years were recruited into the study. A questionnaire, which gathered information on demographic data, family history, and risk factors associated with childhood hypertension and the child's clinical data, was used. An average of three blood pressure readings with an automated sphygmomanometer and height measurement was taken for each child. Blood pressure was categorized as normal, pre-hypertension, and hypertension using the Centers for Disease Control and Prevention (CDC) reference charts. Results: A total of 600 school children comprising 358 (59.7%) females and 242 (40.3%) males were studied. Fifty-one (8.5%) school children had elevated blood pressure. Of these, 15 (2.5%) had hypertension, while 36 (6.0%) had pre-hypertension. Two hundred and thirty-eight participants had a family history of risk factors for hypertension. Twenty-five (10.5%) children with risk factors (family history of hypertension, diabetes mellitus, obesity, stroke) had elevated blood pressure (BP) compared to 7.2% of those without risk factors. Conclusion: Urgent positive lifestyle transformations, which should start from school to reduce the incidence of hypertension in children.
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Our surgical experience in traumatic and congenital diaphragmatic hernia: Single-center study p. 391
O Basol, H Bilge
DOI:10.4103/njcp.njcp_605_20  
Background and Aim: Diaphragmatic hernias can develop congenitally or secondary to trauma. Congenital diaphragmatic hernias occur with Bochdalek hernia and Morgagni hernia (MH). In this study, we aimed to present laparoscopic and open surgical treatment for traumatic and congenital diaphragmatic hernias, and complications and length of hospital stay in the light of the literature. Patients and Methods: Twenty-two patients who were diagnosed with diaphragmatic hernia between January 2013 and January 2020 in our clinic were examined retrospectively in terms of demographic features, clinical and radiological findings, and length of hospital stay. Results: The complaints of the patients diagnosed with diaphragmatic hernia were often abdominal pain, shortness of breath, early satiety, nausea, vomiting, and abdominal distention. The mean age of the patients was 54 (19–88) years. Sixteen patients were females and six were males. Two patients were operated due to stab injury, six patients were operated due to ileus, and the remaining fourteen patients were operated due to congenital diaphragmatic hernia. Eight patients were operated under emergency conditions. The remaining patients were operated under elective conditions. The average hospital stay was 6(3-15) days. The length of hospital stay of those who underwent laparoscopic surgery was 4 (3–5) days. No patient had an exitus. All patients were discharged with healing. This rare pathology should be remembered especially in patients presenting with acute abdominal complaints accompanied by respiratory complaints. Conclusion: We think that cases with MH detected incidentally should be operated laparoscopically before becoming complicated.
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Posture-induced intraocular pressure changes among patients with primary open angle glaucoma in a Nigerian Tertiary Hospital: Any implication for management p. 395
OJ Ireka, OC Arinze, N Ogbu, CE Ogbonnaya, UU Nnadozie, CM Chuka-Okosa
DOI:10.4103/njcp.njcp_642_20  
Background and Aim: To determine the effect of postural changes on intraocular pressure (IOP) among newly diagnosed patients with primary open-angle glaucoma (POAG). Patients and Methods: This was a cross-sectional observational study of 55 consecutive newly diagnosed patients with POAG attending Glaucoma clinics at a Federal Teaching Hospital in Abakaliki, Ebonyi state, from July to September 2017. Patients IOPs were measured in the sitting position, supine without a pillow, and supine with pillow positions using Perkin's handheld applanation tonometer. All data were analyzed with SPSS version 20.0 Results: A total of 55 subjects were recruited comprising 30 (54.5%) males and 25 (45.5%) females, with a mean age of 50.13 ± 9.97 years and an age range of 30–79 years. The mean intraocular pressure was 27.54 ± 3.98 mmHg in the sitting position, 30.15 ± 4.41 mmHg in the supine with pillow position, and 35.22 ± 4.61 mmHg in the supine without pillow position. The mean difference of mean IOP of sitting compared to supine without the pillow was 7.68 ± 2.08 mmHg (P-value < 0.001, 95% CI: 7.12–8.24); sitting compared to supine with the pillow was 2.61 ± 1.49 mmHg (P-value < 0.001, 95% CI: 3.01–2.21), whereas supine without the pillow compared to supine with the pillow was 5.07 ± 2.24 mmHg (P-value 0.001, 95% CI: 4.47–5.68) Conclusion: IOP was lowest in the sitting position and highest in the supine without pillow position. There was a statistically significant reduction in IOP on the assumption of supine with pillow position compared to supine without pillow position. The use of thick pillows in supine positions (such as during sleep or relaxations) rather than lying supine without pillows may reduce IOP spikes in POAG patients. This may have a positive effect as regards treatment and progression of glaucoma.
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Effect of spinal anesthesia on QT interval: Comparative study of severe pre-eclamptic and normotensive parturients undergoing cesarean section p. 401
AM Adedapo, BO Bolaji, MB Adegboye, PM Kolo, JA Ogunmodede, ZA Suleiman, OO Adedapo, OS Jimoh
DOI:10.4103/njcp.njcp_495_20  
Aim: This study aimed to compare the effect of spinal anesthesia on QT interval in severe pre-eclamptic and normotensive parturients who underwent cesarean section in a Nigerian tertiary hospital. Patients and Methods: Twelve-lead electrocardiogram (ECG) was obtained before, and at intervals after spinal anaesthesia on fifty severe pre-eclamptic (Group A) and fifty normotensive parturients (Group B) who underwent caesarean section. The effect of spinal anaesthesia on QT interval was compared. Results: The preoperative (baseline) mean QT interval was longer in group A than in group B; 453.10 ± 34.11 ms versus 399 ± 18.79 ms, P < 0.001. The prevalence of prolonged QT interval in the severe pre-eclamptic group before spinal anesthesia was 80% while in the normotensive group it was 0%, P < 0.001. At 5, 30, 60, and 120 min after the establishment of spinal anesthesia, the mean QT interval in the severe pre-eclamptic group was shortened and maintained within normal limits; 414.74 ± 28.05, 418.28 ± 30.95, 411.18 ± 19.21 and 401.36 ± 17.52 ms with P < 0.001 throughout. In the normotensive group, there was no significant change in the mean QT interval. Conclusions: This study demonstrated that the QT interval was more prolonged among the severe pre-eclamptic parturients. Spinal anesthesia using 0.5% hyperbaric bupivacaine normalized the QT interval and maintained it within normal limits during the study period.
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Predictive value of doppler cerebroplacental ratio for adverse perinatal outcomes in postdate pregnancies in Northwestern Nigeria p. 406
A Ismail, AL Ibrahim, A Rabiu, Z Muhammad, I Garba
DOI:10.4103/njcp.njcp_14_21  
Background: Postdate pregnancy is a very common obstetric condition, increasing the risk of perinatal morbidity and mortality from uteroplacental insufficiency. Aim: To determine the predictive values of Doppler cerebroplacental ratio (CPR), that is, the ratio between middle cerebral artery (MCA) and UA pulsatility indices (UA PI), and other potential velocimetric predictors of adverse perinatal outcomes in women with postdated pregnancies. Patients and Methods: A prospective cohort study was conducted on consenting 212 low-risk pregnant women beyond 40 weeks' gestational age. The pulsatility indices of MCA, UA, and CPR as well as non-stress tests (NST) and amniotic fluid index (AFI) were measured and recorded. The women were divided into two groups based on the presence or absence of adverse perinatal outcome defined as: meconium stained liquor, meconium aspiration syndrome, perinatal asphyxia, cesarean section for suspected fetal distress, and perinatal death. Results: Of the 200 women whose data were available for analysis, 40 (20%) of them had adverse perinatal outcome and 160 (80%) had normal perinatal outcome. The CPR showed statistically significant difference in predicting adverse perinatal outcome (P < 0.001). CPR had a better predictive value than UA-PI and outperformed MCA-PI and NST for adverse perinatal outcomes. The sensitivity, specificity, negative predictive value (NPV), and accuracy of prediction of adverse perinatal outcomes by CPR were 90%, 81.25%, 97.01%, and 83%, respectively. Conclusion: The Doppler CPR shows the highest diagnostic accuracy in prediction of adverse perinatal outcome in pregnant women after 40 weeks' gestation than UA PI and velocimetric indices when used as stand-alone test.
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Electrocardiographic QRS axis shift, rotation and COVİD-19 p. 415
S Koc, VO Bozkaya, AB Yikilgan
DOI:10.4103/njcp.njcp_9_21  
Background: In patients with coronavirus disease-2019 (COVID-19), severe dyspnea is the most dramatic complication. Severe respiratory difficulties may include electrocardiographic frontal QRS axis rightward shift (Rws) and clockwise rotation (Cwr). Aim: This study investigated the predictability of advanced lung tomography findings with QRS axis shift and rotation. Patients and Methods: This was a retrospective analysis of 160 patients. Patients were divided into the following two groups: normal (n = 80) and low (n = 80) oxygen saturation. These groups were further divided into four groups according to the rightward and leftward axis shift (Lws) on the electrocardiographic follow-up findings. These groups were compared in terms of electrocardiographic rotation (Cwr, counterclockwise rotation, or normal transition), tomographic stage (CO-RADS5(advanced)/CO-RADS1–4), electrocardiographic intervals, and laboratory findings. Results: In patients with low oxygen saturation, the amount of QRS axis shift, Cwr, and tomographic stage were significantly higher in the Rws group than in the Lws group. There were no differences in the above parameters between the Rws and Lws groups in patients with normal oxygen saturation. Logistic regression analysis revealed that the presence of Cwr and Rws independently increased the risk of CO-RADS5 by 18.9 and 4.6 fold, respectively, in patients with low oxygen saturation. Conclusion: In COVID-19 patients who have dyspnea with low oxygen saturation, electrocardiographically clockwise rotation with a rightward axis shift demonstrated good sensitivity (80% [0.657–0.943]) and specificity (80% [0.552–>1]) for predicting advanced lung tomographic findings. ClinicalTrialsgov Identifier: NCT04698083.
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Factors effective on recurrence and metastasis in phyllodes tumors p. 425
M Altiok, F Kurt
DOI:10.4103/njcp.njcp_1374_21  
Background and Aim: Phyllodes tumors (PT) are rare biphasic breast tumors containing stromal mesenchyme and epithelial components. It was classified as benign, borderline, and malignant by the World Health Organization (WHO). Although there is no certainty about the size of the desired margin in the surgery to be applied, a tumor-free area of 1 cm is often targeted. Our study aimed to determine the subtype rates in patients with PT and evaluate the surgical margin, recurrence, and survival times obtained after the surgery. Patients and Methods: This study was conducted at Seyhan Goverment Hospital and involved the PT patients treated between January 2010 and June 2020. We analyzed PT patients retrospectively. Sixty-one patients with PT were analyzed. In the patient, demographic characteristics, body mass index (BMI), surgical procedures, tumor type, size, mitosis rate, and distance of tumor to surgical margin were evaluated. During follow-up, reoperation, recurrence, metastasis, survival times, and mortality rates were evaluated. Results: Sixty-one phyllodes breast tumor patients whose histopathology was reported as malignant, borderline, and benign were evaluated and presented in our study. The mean age was 37.84 (15–100), and the BMI was 25.78 (±5.35) mm. Of the 61 patients, 41 (67.2%) were diagnosed with benign phyllodes tumor (BPT), 10 (16.4%) as borderline phyllodes tumor (BLPT), and 10 (16.4%) as malignant phyllodes tumor (MPT). Conclusions: Preoperative diagnosis of PT can reduce the rate of secondary surgical procedures and the loss of extra breast tissue. A large diameter needle and sufficient number of tissue samples for preoperative core biopsy may increase the rate of accurate diagnosis.
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The modified suprapubic prostatectomy technique is associated with improved hemostasis and decline in blood transfusion rate after open suprapubic prostatectomy compared to the freyers technique p. 432
AO Obi, CJ Okeke, AO Ulebe, UU Ogbobe
DOI:10.4103/njcp.njcp_1391_21  
Background: Open suprapubic prostatectomy is attended by significant perioperative haemorrhage and need for blood transfusion. Aim: To share our experience on how the adoption of a modified suprapubic prostatectomy technique has led to improved hemostasis and decline in the blood transfusion rate after open suprapubic prostatectomy in our center. Patients and Methods: This was a retrospective study comparing two open prostatectomy techniques. The patients in group 1 had Freyer's suprapubic prostatectomy while the patients in group 2 had a modified suprapubic prostatectomy technique. The groups were compared for the effectiveness of hemostasis using change in packed cell volume, clot retention, blood transfusion, and requirement of continuous bladder irrigation. Results: Both groups were similar concerning age, body mass index (BMI), total prostate-specific antigen (PSA), prostate volume, presence of comorbidities, duration of surgery, and duration of follow-up. The clot retention rate was 34% in group 1 versus 16.4% in group 2, P = 0.030. The clot retention requiring bladder syringe evacuation occurred in 32.1% of the patients in group 1 versus 14.8% in group 2, P = 0.048. The mean change in the packed cell volume (PCV) in group 1 was 8.0 ± 5.3 versus 6.9 ± 3.5 in group 2, P = 0.175. The blood transfusion rate in group 1 was 40.0% versus 13.3% in group 2, P = 0.040. The complication rate in group 1 was 67.2% versus 41.9% in group 2, P = 0.004. A general decline in blood transfusion was noted from January 2011 to December 2019. Conclusion: The modified suprapubic prostatectomy technique was associated with better hemostasis compared to the standard Freyer's prostatectomy technique. It should be a worthwhile addition to the numerous modifications of the original Freyer's suprapubic prostatectomy technique.
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Prevalence of hyperuricemia and the relationship between serum uric acid concentrations and lipid parameters among King Abdulaziz University Hospital patients p. 439
RA Ghamri, TA Galai, RA Ismail, JM Aljuhani, DS Alotaibi, MA Aljahdali
DOI:10.4103/njcp.njcp_1549_21  
Background: Several studies have associated uric acid with dyslipidemia. However, no previous studies have examined patients without chronic illness. Aim: The aim of this study is to assess the relationship between serum uric acid concentration and lipid profile parameters and to estimate the prevalence of hyperuricemia in the city of Jeddah. Patients and Methods: A retrospective study was conducted on 1206 patients who undergone laboratory blood testing over a 3-year period (2018–2020) at King Abdulaziz University Hospital, which was ethically approved. We used a predesigned checklist to collect data from electronic hospital records using Google Forms. Bivariate analysis, tables, and graphs were used to represent and identify the relationships between variables. A P value of <0.05 was considered significant. Results: Our study revealed a prevalence of 12% for hyperuricemia in the study population. Males were more frequently affected than females (8.13% vs. 3.73%, respectively). There was no association between serum uric acid concentration and lipid profile parameters, including total cholesterol (P = 0.92), triglyceride (P = 0.42), high-density lipoprotein (P = 0.47), and low-density lipoprotein (P = 0.66). There was a strong association between serum uric acid concentration and high body mass index (P < 0.001), older age (P = 0.002), male sex (P < 0.001), and nationality (P < 0.001). Furthermore, there was an association between sex and mean erythrocyte sedimentation rate (P = 0.02) and mean triglyceride concentration (P = 0.02). Conclusion: We observed a low prevalence of hyperuricemia, and our results indicate no association between serum uric acid concentration and lipid profile parameters.
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Preoperative radiotherapy for rectal cancer: A bibliometric analysis of the 100 most-cited research articles p. 448
G Turkkan, A Alkan
DOI:10.4103/njcp.njcp_1592_21  
Background and Aims: Preoperative long-course radio-chemotherapy (LC-RCHT) or preoperative short-course radiotherapy (SC-RT) are widely used in the treatment of locally advanced rectal cancer (LARC). This study aimed to evaluate the 100 most-cited research articles focused on preoperative radiotherapy for rectal cancer to reveal existing academic trends and the direction of therapeutic research. Materials and Methods: This was a retrospective study based on publicly accessible data. The Web of Science database was used to identify the 100 most-cited articles. Results: The median values for total citation and average citation per year (CPY) were 240.50 (range, 150–3787) and 17.32 (5.03–222.76), respectively. Randomized (median: 24.88 vs 13.32, P = 0.001) and funded (median: 27.33 vs 14.73, P = 0.002) studies had more CPY than those with opposite characteristics. No significant difference was found between studies using SC-RT and LC-RCHT, in terms of average CPY (median: 15.27 for SC-RT vs 18.36 for LC-RCHT, P = 0.303). In terms of the primary aim of the investigation, studies investigating non-operative treatment strategies had higher CPY than those investigating other subcategories (p = 0.029). Conclusion: Randomized studies, funded studies, and studies investigating non-operative treatment were associated with more CPY. There remains equal interest in preoperative SC-RT and LC-RCHT for rectal cancer.
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Skeleto-dental features among a sample of Saudi female children compared to British standards: A cephalometric study p. 454
EI AlShayea, K Almoammar, M Alsultan, SF Albarakati
DOI:10.4103/njcp.njcp_1819_21  
Aim: This cross-sectional observational retrospective study aimed at assessing the cephalometric skeleto-dental features of class I, II, and III skeletal relationship of Saudi female school children sample and comparing the results to the established British Caucasian cephalometric standards. Materials and Methods: The sample consisted of 205 retrospective lateral cephalometric radiographs of female school children. The age range of the subjects were between 10 and 13 years old with a mean age of 11 ± 1 years. Several cephalometric and constructed points were identified. Angular, linear, and proportional measurements were obtained and analyzed. The skeleto-dental features of class II and class III were compared to class I of this sample and then compared with the established British Caucasian population. Different angular, linear, and proportional variables were investigated. Descriptive statistics and Student's t-test were used for data analysis. Results: The distribution of the skeletal relationship revealed that 68.3% of the sample showed class I relationship, 16.1% class II, and 15.6% class III. The result indicates significant differences among the different classes. A greater tendency towards class II facial pattern and more convex profile among Saudis were detected in the present study compared to Caucasians. Furthermore, The dento-alveolar relationship results showed more bi-maxillary protrusion among Saudi females compared to the British Caucasians. Conclusion: The results of the study can serve as a base-line for future investigations in Saudi Arabia. Furthermore, the results obtained can also be of great value in distinguishing the various skeleto-dental features in the different skeletal classes among the Saudi females, and in the clinical diagnosis and treatment planning.
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Evaluatıon of Pituıtary/Cranial imagıng results of central puberty precocıous cases p. 466
HN P Kendirci, I Kaba, N Fidan
DOI:10.4103/njcp.njcp_1866_21  
Background: The activation of the gonadotropin-releasing hormone (GnRH) pulse generator before the age of 8 years in girls and 9 years in boys results in central precocious puberty (CPP). Previous studies have shown that the height of the pituitary gland in the CPP cases is higher than in the normal children. Aim: In this study, ıt was aimed to evaluate the pituitary gland volüme by MRI in CPP children, and explore the intracranial lesions among children with CPP. Patients and Methods: The study was performed with 50 children (41 girls, 9 boys) who had been diagnosed with CPP. Pituitary MRI was performed in every child after the diagnosis of CPP. Pituitary gland volüme in CPP children was compared with age/sex-matched control subjects. In addition, if available, cranial MRI of patients were evaluated for the presence of additional intracranial abnormalities or space-occupying lesions. Results: The mean chronological age at diagnosis was 7.1 ± 1.0 (2.4–7.9) years in girls and 7.4 ± 1.7 (3.7–8.8) years in boys. CNS imaging showed pathological findings in 17% (7/41) of the girl cases and 55.5% (5/9) of the boy cases. Pituitary volumes of girls aged 6.0–7.9 years and boys aged 8.0–8.9 years were found to be increased compared to the control group. Conclusion: In this study, we found that CNS imaging showed pathological findings in 17% of the girl cases, and 55.5% of the boy cases. Pituitary volumes of girls aged 6.0–7.9 years and boys aged 8.0–8.9 years were found to be increased compared to the control group.
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Shoulder tip pain after cesarean section: General versus spinal anesthesia p. 473
F Simsek, U Kara, ME Ince, E Sir, S Eksert, G Ozkan, S Senkal
DOI:10.4103/njcp.njcp_1709_21  
Background and Aim: Shoulder tip pain is a common but overlooked complication during the postoperative cesarean section. In this study, we aimed to investigate the relationship between the anesthesia method and the incidence of shoulder tip pain. Patients and Methods: In this randomized clinical study, 117 patients who underwent cesarean section were divided into two groups as spinal anesthesia and general anesthesia. The demographic characteristics, the presence, the severity of shoulder tip pain, and also analgesic consumption in the first 24 hours were compared. Results: The incidence of shoulder tip pain was significantly higher in the spinal anesthesia group than in the general anesthesia group (p = 0.032). While there was no statistically significant difference in terms of the number of patients who needed opioid treatment within the first 24 hours between patients with and without STP, a statistically significant difference was observed in terms of the use of nonsteroidal anti-inflammatory drugs (p < 0.001). Conclusions: This study shows that the frequency and severity of shoulder pain are higher in women who have had cesarean section under spinal anesthesia, compared to those who had received general anesthesia.
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Pre-operative 2-D transthoracic echocardiographic diagnosis with intra-operative findings of children with structural heart diseases: A comparative analysis p. 478
FA Ujunwa, JM Chinawa, V Okwulehie, EK Obidike
DOI:10.4103/njcp.njcp_1714_21  
Background: Structural heart disease is a major cause of morbidity and mortality in children. Echocardiography is accepted as the first line cost-effective diagnostic modality for pre-operative assessment of children with structural heart diseases. Two-dimensional transthoracic echocardiography (2-D TTE) may be the only diagnostic tool in a resource-poor environment where further investigations may be very expensive and not readily available. Aim: The aim of the study is to determine the degree of accuracy of pre-operative 2-D echocardiographic diagnosis with eventual surgical (intra-operative) findings among children with structural heart diseases with a view to audit the echocardiographic diagnoses and final surgical diagnoses among the patients in the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, a tertiary cardiothoracic center in Enugu, South-east Nigeria. Patients and Methods: 2-D TEE (GE Model) diagnosis of all the children that had cardiac surgery at University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla Enugu over a 3-year period was studied. All the patients had at least two echocardiographic sessions and results were recorded in a proforma. Surgical findings were obtained from post-operative surgical notes. Intra-operative findings were compared with 2-D TTE findings. Data were analyzed using SPSS version 20. The degree of accuracy was expressed as percentages. The relationship between the sensitivity of 2-D TTE and intra-operative findings as ascertained using sensitivities and positive predictive values. Results: There were 55 pediatric cardiac operations performed within the period under review. There were 22 males and 23 females, the age range was from 8 months to 17 years. Fifty-two (94.5%) were due to congenital heart diseases, whereas three (5.5%) were due to acquired heart diseases. Echocardiographic findings were the same as surgical findings in all isolated PDAs (100%), Isolated ASDs (100%), Mitral valve regurgitation three (100%), but missed out PDA as an associated finding in a case of sub-aortic VSD (7.7%) and an ASD in a case of TOF (5.9%), congenital absence of tricuspid valve was also missed as a component of complex cardiac anomaly one (1.1%). These omissions however did not change the surgical approach and outcome. Pre-operative echocardiographic diagnoses and eventual surgical diagnoses were largely concordant. The sensitivity of 2-D TTE and intra-operative findings is 94.5%, positive predictive value is 94.5%, and the false negative rate is 5.5%. Conclusion: Echocardiography is a veritable diagnostic tool in the pre-operative evaluation of children with structural heart diseases. Continuous training and re-training are key in skill development and capacity building in resource-poor countries.
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Retrospective evaluation of peripartum hysterectomy patients: 8 years' experience of tertiary health care p. 483
S Gulucu, KE Uzun, AZ Ozsoy, IB Delibasi
DOI:10.4103/njcp.njcp_1722_21  
Background: Peripartum hysterectomy (PPH), which means surgical removal of the uterus during pregnancy or postpartum period, is a life-saving procedure performed as a last resort to stop obstetric serious bleeding. Aim: Evaluation of the prevalence, risk factors, indications, associated complications, and neonatal outcomes of PPH performed in our clinic. Patients and Methods: A total of 35 patients who underwent PPH in our clinic between 2013 and 2020 were analyzed retrospectively. Clinical and demographic characteristics of patients, age, gestational week, delivery type, type of hysterectomy performed, length of hospital stay, PPH indications, additional procedures and complications during PPH, maternal and fetal mortality, neonatal characteristics, intensive care unit (ICU) need after PPH, and blood transfusion amount and time were recorded. Patients with PPH were subdivided and studied in subgroups: Emergency - elective surgery, total - subtotal hysterectomy. Results: PPH was performed in 35 (3.2/1000) patients who gave birth during the study period. The most common indication for hysterectomy was placental invasion anomaly (57.1%, n = 20), and the most performed operation was total hysterectomy (68.6%, n = 24). Bilateral hypogastric artery ligation (14.3%, n = 5) was the most common alternative procedure performed before hysterectomy, and the most common complication was bladder injury (22.9%, n = 8). Blood transfusion was performed in 94.3% (n = 33) of the patients due to acute blood loss. The mean newborn weight was 2788.79 ± 913.37 g, and the 1st and 5th-minute APGAR scores were 6.71 ± 2.25 and 7.56 ± 2.35, respectively. Conclusion: Before PPH, uterine integrity should be preserved using medical and surgical methods, but if success is not achieved, hysterectomy is the last life-saving step. It should be kept in mind that in patients with anemia and increased gravidity, the risk of bleeding may be high in the first 24 h after birth and therefore PPH may be required. It would be more appropriate for patients with placentation anomalies to be operated in experienced centers due to possible complications, increased blood transfusion, and intensive care requirement.
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A study of spectrum of sickle cell anemia and thalassemia in a teaching institute of South India p. 490
SS Sabitha Rani, IS Vamshidhar, S Bangaru, NA John, J John
DOI:10.4103/njcp.njcp_1742_21  
Background and Aim: Sickle cell syndrome is a group of inherited hematological disorders with varying degrees of anemia, jaundice, fatiguability along with hepatomegaly and splenomegaly. The clinical presentations can be may vary and therefore require thorough investigations. We tried to evaluate the spectrum of sickle cell anemia and thalassemia in pediatric patients of our hospital. Patients and Methods: In this cross-sectional study, A total of n = 200 consecutive cases were detected during the period of study. A thorough history and detailed clinical examination were done. Hb electrophoresis was done in the present study using HYDRASYS ® Electrophoresis Systems from Sebia. Results: The overall prevalence of SCD in our study was 6.83% the existence of this is found to be greater in the males as compared to females which is in agreement with prevalence across India with more male than female. Thalassemia was prevalent at the rate of 3.96%, sickle cell anemia had a prevalence of 1.98% sickle thalassemia was 0.89%. N = 20 pairs of Parents recognized genetic counseling i.e., with a single child or who wanted further children readily underwent HPLC analysis. Conclusion: The existence of SCD in our study group is lesser as compared to the South India average. Preventive programs consisting of public education, population screening, genetic counseling, and prenatal diagnosis have been very effective in reducing both rates of β-Thalassemia major. Sickle cell anemia is of prime importance because of its high prevalence, morbimortality and the absence of curative treatments.
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Whole-body CT indications in emergency medicine trauma patients p. 496
E Ozcete, I Uz, B Arslan, S Yalcinli, YA Altunci
DOI:10.4103/njcp.njcp_1727_21  
Background: Whole-body computerized tomography (CT) scan designed as early diagnosis of traumatic injuries and prevention of unnoticeable injuries. Using Whole-body CT in trauma patients still controversial, there is no consensus on indications. Aims: The aim of this study is to clarify indications and cut-off levels in vital parameters in trauma patients who undergo Whole-body CT to prevent unnecessary or negative scans. Patients and Methods: We evaluated patients with trauma who applied our emergency service between 01.09.2019 and 30.09.2020. Patients above 18 years old with Whole-body CT scan included. Whole-body CT reports were evaluated according to five categories; cranial-face, vertebra, thorax, abdomen, pelvis-bone. Results: The review of whole-body CT reports, 46.3% detected normally. But, 53.7% of patients had injuries at least one zone, 23.3% at least two zones, and 7.4% at least three zones respectively. Prediction criteria of Whole-body CT for the patients with two or three zones injury, systolic blood pressure (SBP) ≤100 mm Hg, Glasgow coma scale (GCS) <15, and free fluid in Focused Assessment with Sonography for Trauma (FAST) were independent variables in regression analysis. When patients had at least one of three variables, the negative predictive value of whole-body CT was 96% for three zones and 91% for two zones. Conclusion: The cut-off values of GCS <15 and SBP ≤100 mm Hg were useful vital parameters in making whole-body CT decisions in trauma patients in the emergency service. Also, free fluid detection in FAST can be used for whole-body CT decisions.
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Attitudes and practices of tobacco cessation counseling among Saudi dental professionals: A nationwide cross-sectional survey p. 502
E Halboub, MA Jafer, HI Khormi, AA Kariri, SA Atiah, SJ Lughbi, R Ba-Hattab, SA Al-Maweri
DOI:10.4103/njcp.njcp_1784_21  
Background: Dental professionals can play a pivotal role in educating the public about the harmful effects of smoking and encouraging them to quit the habit. Aim: This study assesses the attitudes and practices of tobacco cessation counseling (TCC) among dental professionals in Saudi Arabia. Patients and Methods: This questionnaire-based cross-sectional study targeted dentists and dental interns working in government and private sectors in Saudi Arabia. We conducted a descriptive analysis by using SPSS Statistics, version 25.0. Results: A total of 895 respondents (314 interns and 581 dentists) participated in this survey. Although the majority of respondents (93%) reported that they always ask patients about tobacco habits, only 59% reported recording tobacco habits in patients' files, and only 55% of the respondents reported explaining to patients the harmful effects of tobacco. Around 91% of the participants believe that a dental clinic is an appropriate place for TCC, and 22% believe that TCC has a negative impact on dental practice. Smoking status, work setting, and the number of years since graduation were found to be significantly associated with the respondents' attitudes and practices. Lack of training, time limitations, and lack of confidence were barriers for TCC. Conclusions: Dental professionals in Saudi Arabia demonstrated relatively positive attitudes but weak practices of TCC. Continuous education and motivation are needed to improve dentists' confidence, attitudes, and willingness for TCC. Integration of tobacco control education in undergraduate curricula is recommended.
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Can the hydrogel form of sodium ascorbate be used to reverse compromised resin infiltrant penetration after bleaching? p. 509
IS Sadikoglu, M Arici, H Kemaloglu, M Turkun, MG Caymaz
DOI:10.4103/njcp.njcp_1805_21  
Aims: The aim of this study was to investigate the effects of an antioxidant on the bleaching-induced reduction in the penetration depth of infiltrant resins. Materials and Methods: White spot lesions (WSLs) were created on 105 bovine tooth samples, each measuring 6 × 4 × 4 mm. Five samples were randomly selected for the examination of lesion characteristics. The remaining 100 samples were then divided into four groups (n = 25). In Group I, the WSLs were treated with resin infiltration (RI) only. RI was performed on Group II immediately after bleaching. In Group III, an antioxidant was applied for 2 h after bleaching, and this was immediately followed by RI. The Group IV samples were treated with RI at the end of a 1-week waiting period after bleaching. The penetration depths were evaluated through confocal laser scanning microscopy. Results: The lowest penetration rate, which was approximately 57%, was observed in Group II. This was followed by Group III (87%), Group IV (90%), and Group I (92%). Group II, in which the samples were infiltrated immediately after bleaching, had the lowest mean penetration percentage. All the bleached groups exhibited significantly lower penetration percentages than the nonbleached group (Group I) (P < 0.05). Antioxidant application increased the penetration significantly (P < 0.05). Conclusion: Application of sodium ascorbate was found to reverse the reduced resin penetration depth and penetration percentages resulting from bleaching. The postponement of adhesive procedures after bleaching yielded similar results.
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Assessment of the effects of different dental restorative materials on radiotherapy dose distribution: A phantom study p. 516
Alper Ozseven, Muhittin Ugurlu
DOI:10.4103/njcp.njcp_1826_21  
Background: One of the most specific effects of high-density dental restorative materials on head & neck cancer radiotherapy is generating variations on isodose distributions. These variations might have an impact on the accuracy and effectiveness of the radiation treatment. The aim of this study is investigating the possible dosimetric effect of six different restorative materials on isodose distributions in head & neck radiotherapy planning process. Materials and Methods: A special phantom was developed and twenty-one caries-free human third molars (a control group + six different restorative materials) were used for the measurements. After acquiring the computed tomography (CT) images, seven treatment plans were created. Hounsfield Unit (HU) numbers, horizontal line dose profile (HLDP) and vertical line dose profiles (VLDPs) were compared with the control group. Results: The amalgam sample deformed the HU numbers in CT images. The median HU value for the S4 material was considerably different than the other samples. The median values were quite close for the remaining samples. For the amalgam sample, the mean of the calculated median isodose values for HLDP and VLDP at 3.5 cm away from the isocenter line were lower than the mean of the control group 4.03% and 6.94%, respectively (for HLDP with tooth numbers of 36 and 38 P = 0.025 and P < 0.001, respectively; for VLDP P < 0.001). In C-S1 comparison results, the statistically significant differences were found for the measurement point at 1 cm away from the isocenter (P = 0.037, P = 0.002, and P = 0.018 for the tooth numbers 36, 37, and 38, respectively). In C-S2 and C-S6 comparisons, there was a statistically significant difference for tooth number 36 (P = 0.035 and P = 0.003, respectively). Conclusions: The findings of the present study showed that amalgam should not be used in head & neck cancer patients who are planned to have radiation therapy. A high viscosity glass ionomer cement (GIC) and a ceramic reinforced GIC sample can be used instead of amalgam to minimize the distorting effect on isodose distributions.
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Evaluation of dentinal crack propagation, amount of gutta percha remaining and time required during removal of gutta percha using two different rotary instruments and hand instruments - An In vitro study p. 524
S Tejaswi, A Singh, S Manglekar, UK Ambikathanaya, S Shetty
DOI:10.4103/njcp.njcp_1838_21  
Background: One of the most important goal of non surgical endodontic retreatment is the successful removal of gutta percha and sealers from the root canal system. A variety of techniques have been recommended for retreatment procedures for the removal of gutta-percha and sealers with or without the help of adjunctive chemical solvents, by using stainless steel hand files or nickel-titanium rotary files, gate glidden burs, heated instruments, ultrasonic instruments, and lasers 1,3. The current advancements in the design of NiTi instruments have proved efficacious in the removal of filling materials from the root canal wall and various studies have also confirmed their cleaning ability and efficacy 4,5. Nevertheless, the use of rotary instrumentation can lead to the formation of dentinal cracks in the root canal dentin. Many researchers have reported the incidence of crack formation and propagation after the procedure with manual, rotary and reciprocating instruments. The behavior of rotary instruments in the generation of defects have been the point of greatest interest during many years 6. These dentinal cracks can be defined as defects with a complete crack line extending from inner root canal space up to the outer surface of the root when the tensile stress in the root canal wall exceeds the tensile stress of dentin 7. Aim: This study was conducted to investigate and to compare the amount of dentinal microcracks formation with various new instrumentation methods and conventional hand filing method. It also looks into amount of gutta-percha removed after retreatment from the canal and the time required for all the instrumentation technique. Methodology: Sixty extracted human maxillary first molars with curved roots were mounted on addition silicone impression material incorporated in an aluminium hollow block, then instrumented using step-back preparation with 35 size K files. Obturation was done using gutta-percha with AH plus sealer. These were stored for 14 days and divided into three groups Mani GPR, Endostar Re Endo and H file and were subjected to retreatment procedures. Retreatment was considered complete when no filling material was observed on the canal wall and the canal was smooth and free of visible debris. The samples were examined under scanning electron microscope and the number of cracks were calculated. The percentage of root canal filling material and time taken was recorded. Statistical Analysis: The data obtained were analyzed by using descriptive statistics, ANOVA (Analysis of Variance), chi-square test and Scheffe's post hoc test through SPSS for window (version 22.0). Result: All the techniques showed similar amount of crack propagation, with no statistical difference between the group. Retreatment done using H Files required more time and removed less material. The coronal third showed less amount of gutta-percha remnants than the apical third in all groups. Conclusion: All the groups showed a similar amount of crack propagation. Less number of cracks were observed in the coronal one third and more amount of cracks were found at the apical third. Endostar RE Endo rotary instrument proved to be most effective and least time-consuming. Hedstrom Files required more time and removed less material.
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Are preoperative CT parameters predictive for the outcome of septoplasty? p. 531
N Sari, F Cankal, E Uysal
DOI:10.4103/njcp.njcp_1842_21  
Background: Despite successful septoplasty surgery, some patients still complain of nasal obstruction (NO). Aim: Our aim in the present study is to determine whether preoperative computed tomographic (CT) parameters have prognostic significance for the success of septoplasty. Material and Methods: Retrospective data from 61 patients in a secondary care hospital who had undergone septoplasty met the inclusion and exclusion criteria. The effects of demographic and preoperative CT parameters (internal nasal valve [INV], external nasal valve area, angle of septal deviation, choana area, aperture pyriformis area, high septal deviation [HSD], transverse diameter of midnose, anterior/posterior deviation, concha and meatus diameter [superior, middle, inferior]) were studied in relation to the change in NOSE scores and the success of surgery. Results: Of the 61 patients studied, 31 were male (51%) aged 18–55 years with a mean age ± SD (26.59 ± 9.41). It was found that the changes in NOSE scores were significantly different from each other (P < 0.01). Male gender, trauma history, moderate septal deviation, HSD, mucosal pathology, posterior deviation, bullous turbinate (right and left middle, right superior), and in the absence of allergy, paradoxical turbinate (right and left middle and superior), S-shaped deviation were found to have a significant correlation in the change of NOSE scores (P < 0.05). Age and internal valve differed with respect to outcome (P < 0.05). Variables in multiple linear regresion models of all parameters were found to be insignificant (P < 0.05). Conclusion: Preoperative CT parameters are informative, but do not predict the postoperative success of septoplasty.
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Ricketts' E-line profile preferences among Nigerian orthodontists, orthodontic trainees, and a young undergraduate students' population p. 541
O Otuyemi, D Afolabi, T Oyewole
DOI:10.4103/njcp.njcp_1873_21  
Aim: This study compared the perceptions of orthodontists, orthodontic trainees, and young university undergraduate students in Nigeria regarding facial profile attractiveness and the need for orthodontic treatment. Materials and Methods: We used a photo-editing software to alter the lips on Ricketts' esthetic line (E-line) in a lateral silhouette to produce five silhouette profiles with 2 mm incremental changes in the upper and lower lips from the 'normal' position on the E-line (-4 mm/-2 mm to + 4 mm/+6 mm). Two hundred and thirty-two participants (consisting of six groups) ranked the five profiles on a 5-point Likert scale (least attractive, 1 to most attractive, 5). Participants also assessed whether orthodontic treatment was needed to improve facial esthetics. Data were analysed in SPSS 20. Intra-rater reliability was assessed using Cohen's Kappa. We tested the null hypothesis (P ≤ 0.05) that ranked preferences between groups using the Kruskal-Wallis test. Mann-Whitney U test was also used to assess pairwise comparisons between the groups. Results: Intra-rater reliability for facial profiles and treatment needs were moderately acceptable (perceptions ≥67.7%; treatment needs ≥67.0%). Perceptions between orthodontists and orthodontic trainees were not significantly different. However, orthodontists/trainees tended to rank the 'normal' Ricketts' E-line profile as most attractive, while students preferred more protrusive lips. Participants' age rather than sex significantly influenced esthetic preferences. About one-half of all participants (46.6%) ranked the 'normal' Ricketts' E-line as unacceptable; hence required orthodontic treatment to improve their facial attractiveness. Conclusion: Clinical/professional judgment and age significantly influenced participants' perceptions of facial attractiveness. Most participants preferred slightly protrusive lips.
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Nigerian resident doctors' work schedule: A national study Highly accessed article p. 548
SA Balogun, AE Ubom, AO Adesunkanmi, OJ Ugowe, AO Idowu, IK Mogaji, NC Nwigwe, OJ Kolawole, EE Nwebo, AA Sanusi, AA Odedeyi, OV Ogunrinde, OO Adedayo, CU Ndegbu, AS Ojo, CO Anele, OE Ogunjide, O Olasehinde, IO Awowole, OA Ijarotimi, EO Komolafe
DOI:10.4103/njcp.njcp_1901_21  
Background and Aim: The deleterious effects of Resident Doctors' (RDs') long duty hours are well documented. Driven by concerns over the physician's well-being and patient safety, the RDs' duty hours in many developed countries have been capped. However, in Nigeria and many African countries, there are no official regulations on work hours of RDs. This study evaluated the work schedule of Nigerian RDs and its impact on their wellbeing and patient safety. Subjects and Methods: A national survey of 1105 Nigerian RDs from all specialties in 59 training institutions was conducted. With an electronic questionnaire designed using Google Forms, data on the work activities of RDs were obtained and analyzed using the IBM SPSS software version 24. The associations were compared using Chi-squared test with the level of significance set at < 0.05. Results: The mean weekly duty hours (h) of the RDs was 106.5 ± 50.4. Surgical residents worked significantly longer hours than non-surgical residents (122.7 ± 34.2 h vs 100.0 ± 43.9 h; P < 0.001). The modal on-call frequency was two weekday on-calls per week (474, 42.9%) and two weekend on-calls per month (495, 44.8%), with the majority of RDs working continuously for up to 24 hours during weekday on-calls (854, 77.3%) and 48–72 hours during weekend on-calls (568, 51.4%), sleeping for an average of only four hours during these on-calls. The majority of RDs had post-call clinical responsibilities (975, 88.2%) and desired official regulation of duty hours (1,031, 93.3%). Conclusion: The duty hours of Nigerian RDs are currently long and unregulated. There is an urgent need to regulate them for patient and physician safety.
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