Medical and Dental Consultantsí Association of Nigeria
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   Table of Contents - Current issue
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December 2022
Volume 25 | Issue 12
Page Nos. 1949-2082

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ORIGINAL ARTICLES  

The effects of disinfection with Er, Cr:YSGG laser, application of CPP–ACP and sodium hypochlorite on shear bond strength Highly accessed article p. 1949
Z Ersan, I Yazicioglu, AB Serin, MC Dogan
DOI:10.4103/njcp.njcp_1594_21  
Background: The effects of commonly used antimicrobial and anticariogenic agents on the adhesion of pit and fissure sealants were investigated in this study. Aims: The aim of this study is to evaluate the effects of erbium, chromium: yttrium-scandium-gallium-garnet (Er, Cr:YSGG) laser disinfection, casein phosphopeptides–amorphous calcium phosphate (CPP–ACP) containing paste and sodium hypochlorite application before the placement of a resin-based pit and fissure sealant on the shear bond strength of primary tooth enamel. Materials and Methods: The shear bond strength test evaluated the bond strength of sealants on the buccal enamel surfaces of primary molar teeth. The study groups were pit and fissure sealant without any preapplication, pre application of disinfection with Er, Cr:YSGG laser, disinfection with Er, Cr:YSGG laser and CPP–ACP containing paste, sodium hypochlorite, sodium hypochlorite and CPP–ACP containing paste and CPP–ACP containing paste. The pit and fissure sealants were placed using 4 mm diameter, 2 mm height cylindrical plastic tubes. Shear force was applied to each sample. The surfaces of the broken samples were detected under stereomicroscope and were grouped as adhesive, cohesive, and mixed. The results of the study were evaluated using the SPSS 16.0 package program for statistical analysis Results: The groups where sodium hypochlorite and sodium hypochlorite with CPP-ACP were applied showed the lowest bond strength (p < 0.05). It was observed that most of the failures in these groups were adhesive-type failures. No significant difference was observed between the shear bond strengths of the other groups (p < 0.05). Conclusions: Er, Cr: YSGG laser and CPP-ACP containing paste are alternative methods for pre-application of fissure sealants.
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Study of pharyngeal airway morphology with CBCT: Benefits of four premolar extraction orthodontic treatments p. 1955
MR Fang, XZ Yan, JL Ni, YG Gu, L Meng, LC Yuan, HY Cai, LR Wang, JW Qin, Q Cai, Y Zhang, SY Guo
DOI:10.4103/njcp.njcp_1815_21  
Background and Aim: Four premolars extractions are routine procedures for correction of malocclusion, but will inevitably lead to a reduction of tongue space, whether this will weaken the pharyngeal airway remains a controversy. Patients and Methods: Cone-beam computed tomography (CBCT) radiographs of 80 patients who completed four premolar extraction orthodontic treatments were collected and divided into three anteroposterior skeletal groups according to the ANB (angle subspinale to nasion to supramentale) value. Linear, angular, cross-sectional area, and volumetric dimensions of the pharyngeal airway were measured using Dolphin Imaging 11.9 software. One-way analysis of variance and Pearson's correlation coefficient test were performed to assess the intergroup comparisons. Treatment changes were evaluated with two-sample t-tests. Results: In intergroup comparisons, vertical linear and cross-sectional area differences were identified in S-Go/N-Me, VD1, VD1/N-Me, VD2/N-Me, AA, OAA and OMINI (p<0.05), while other measurements showed no significant differences. Angle2, the tilting degree of the pharyngeal airway, showed a positive correlation with ANB (p<0.05). As for the treatment changes, a significant increase was found in the pharyngeal airway in the Class I group (OUA p<0.05, VD1 p<0.001, VD2 p<0.05) and Class II group (VD1 p<0.001. VD2, p<0.05), and inversely, a significant decrease was found in the pharyngeal airway in the Class III group (OAA p<0.05, OMINI p<0.05, OUA p<0.05). No volumetric difference was identified. Interestingly, regarding the preoperative pharyngeal airway size, values trended to the mean value significantly. Conclusion: Four premolar extraction orthodontic treatments did not affect the pharyngeal airway volume except for the vertical liner and cross-sectional area dimensions. The trend of the gold standard suggested a positive influence of four premolar extraction orthodontic treatments.
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Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy p. 1963
H Sa'idu, SA Balarabe, NA Ishaq, UG Adamu, IY Mohammed, I Oboirien, EM Umuerri, AC Mankwe, VY Shidali, P Njoku, S Dodiyi-Manuel, T Olunuga, V Josephs, AC Mbakwem, H Okolie, MA Talle, MS Isa, RA Adebayo, J Tukur, SA Isezuo, H Umar, MN Shehu, OS Ogah, KM Karaye
DOI:10.4103/njcp.njcp_2005_21  
Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90–99, 100–109, 110–119, 120–129, 130–139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90–99 mmHg, 24.7% had 100–109 mmHg, 24.7% had 110–119 mmHg, 18.5% had 120–129 mmHg, 7.5% had 130–139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90–99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49–10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91–0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or β-receptor blockers had an HR of 1.71 (95% CI 0.93–3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.
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Does combined usage of FFP2 and Surgical mask against SARS-CoV-2 affect SpO2 values and pulse rates of dental health-care workers? p. 1969
C Bal, M Aksoy, Z Ozturk, M Unuvar, Y Arslan
DOI:10.4103/njcp.njcp_6_22  
Background and Aim: Combined use of surgical mask with filtering facepiece (FFP) 2 masks has been popular among the health-care workers. However, the effect of this preference on the vital values of individuals stays as a challenge among the professionals. The present study aimed to assess the effect of FFP2 mask versus combined use of it with surgical mask on the SpO2 values and pulse rates of individuals. Patients and Methods: This study was conducted on 20 health-care workers. The pulse rates and SpO2 values were evaluated by pulse oximeter placed in the index fingers of the participants. The participants were divided into two groups: those using the FFP2 mask and those using FFP2–surgical mask combination. Individuals wearing FFP2 mask were examined for a period of 60 min and the same examination was repeated for another period of 60 min in those using combination of FFP2 with surgical mask. The values were measured at the beginning and at 15, 30, 45, and 60 min intervals, respectively. The examinations were conducted in the rest position to obtain standardization. Results: The observed data showed no statistical difference at all periods in either SpO2 values or pulse rates between FFP2 and FFP2–surgical mask combined groups. The SpO2 values reduced from the initial time to 15 min in the FFP2–surgical mask group. Also, in the FFP2–SM group, statistically significant increase in values was observed between 15 and 45 min and 15 and 60 min. Another increase in SpO2 value was found in the observations made between made 30 and 45 min in the same group (P < 0.05). The pulse rates of the individuals showed no statistical difference in both the groups and at all experimental periods (P > 0.05). Conclusion: According to the present study, wearing only the FFP2 mask or FFP2–surgical mask combination seems not to cause any effect on the SpO2 values and pulse rates of the participants.
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An effective artificial testing model to reliability experiments for electronic apex locator devices used in endodontic practice p. 1973
O Ozdemir
DOI:10.4103/njcp.njcp_27_22  
Background and Aim: This experimental study aimed to investigate the reliability of using electronic apex locator devices to determine the working length of artificial root canals. Materials and Methods: The experiments were performed using resin endoblocks and mandibular canine teeth (n = 20/group). After the same working length of root canal samples was provided, the teeth and artificial root canals were embedded in an alginate mold. The measurements with Root ZX® and Propex Pixi® apex locators were performed and recorded. The data were analyzed using SPSS software (SPSS V23; IBM Corp., Armonk, New York, USA) and the variance was set at P < 0.05. Results: There was no significant difference between the groups; mean distance from the actual working length using different apex locators (P = 0.633, P = 0.474), and endpoint positioning distributions (P = 0.591). Conclusion: The results indicate that the artificial model could be a laboratory method of determining the accuracy of apex locators and efficient calibration of devices before their clinical use.
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Diagnostic role of video-assisted thoracoscopy in the management of indeterminate pleural effusion p. 1978
NJ Eze, CI Nwagboso, SO Ogbudu, E Chidiebere, OO Bassey, AU Etiuma
DOI:10.4103/njcp.njcp_311_22  
Background: The management of pleural effusion usually involves the drainage of the effusion, identification, and treatment of the underlying cause (s). Studies have shown that the initial diagnostic techniques do not give conclusive diagnosis in some cases of pleural effusion. This group of patients described as patients with indeterminate or undiagnosed pleural effusion constitutes a significant proportion of patients with pleural effusion in clinical practice. In this study, we examined the role of video-assisted thoracoscopy (VAT) in the diagnostic work-up of these patients. Aim: To determine the diagnostic outcome of VAT in the management of indeterminate pleural effusion in our center. Patients and Methods: Consecutive patients who presented with pleural effusions and who met the inclusion criteria had video-assisted thoracoscopy for diagnostic purposes. Outcome measures including the diagnostic yield, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VAT in patients with indeterminate pleural effusion, duration of the procedure, duration of hospitalization after the procedure, and complications for all the patients were documented and analyzed. Results: Of the 22 patients with indeterminate pleural effusion, conclusive diagnosis was obtained in 18 (81.8%) with a sensitivity of 91.7% [95% confidence interval (CI); 61.5–99.8%], specificity of 100% (95% CI; 69.1–100%), PPV of 100% (95% CI; 0–100%), and NPV of 90.9% (95% CI; 60.5–98.5%) for malignancy and a sensitivity of 78% (95% CI; 40–97%), a specificity of 100% (95% CI; 75.3–100%), PPV of 100% (95% CI; 0–100%), and NPV of 86.7% (95% CI; 65.7–95.7%) for tuberculosis. Conclusion: Our results show that video-assisted thoracoscopy plays a useful role in our center in obtaining diagnosis in patients with indeterminate pleural effusion.
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Comparison of preoperative anxiety, bruxism, and postoperative pain among patients undergoing surgery for septoplasty, endoscopic sinus surgery, and tympanoplasty p. 1984
Y Atar, S Karaketir, H Sari, C Çelik, I Aydogdu, SG Karaketir, Z Saltürk, TL Kumral, B Tutar, M Berkiten, ME A Anarat, G Berkiten
DOI:10.4103/njcp.njcp_400_22  
Background: Septoplasty, endoscopic sinus surgery, and tympanoplasty are the most commonly performed elective functional ear–nose–throat surgeries. Aim: This study investigated the relationship between preoperative anxiety, bruxism, and postoperative pain in inpatient groups undergoing three different functional otorhinolaryngologic surgeries. Patients and Methods: This study was conducted in a single center of a tertiary referral hospital. The patients (n = 90) who had undergone septoplasty (group A), endoscopic sinus surgery (group B), and tympanoplasty (group C) were included. The State-Trait Anxiety Inventory (STAI) questionnaire and the Amsterdam Preoperative Anxiety Information Scale (APAIS) were administered. To evaluate bruxism, a self-questionnaire was administered, and for the evaluation of pain, the visual analogue scale (VAS) was administered. Results: In group C, preoperative STAI and APAIS and early and late pain values were higher than in the other groups. When patients were divided into two groups according to the presence of bruxism. A significant difference was found between the preoperative STAI and immediate and late VAS values (P < 0.001). A strong correlation was observed between APAIS and early and late VAS values in group C (P < 0.001). Conclusion: Patients who will undergo tympanoplasty should be aware of the preoperative anxiety level and pain follow-up. Bruxism can be considered a vital follow-up parameter that manifests due to high preoperative anxiety. It may also be useful to examine preoperative bruxism and take appropriate measures due to its pain-increasing effect in patients.
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Prevalence of hearing loss among newly diagnosed highly active antiretroviral therapy (Haart) naive adult patients in port harcourt p. 1992
AE Ude, OB da Lilly–Tariah, LO Onotai, S Chinenye
DOI:10.4103/njcp.njcp_425_22  
Background: Numerous studies have reported a relationship between human immune deficiency virus (HIV)/acquired immune deficiency virus (AIDS) and auditory functions. There is a dearth of information on the prevalence of hearing loss among newly diagnosed HAART naïve adult patients. Aim: This study therefore provides baseline information on the prevalence of hearing loss among newly diagnosed HAART naïve adult patients in Port Harcourt and serves as a reference for the role of HAART in HIV related hearing loss and for future studies. Patients and Methods: This is a prospective cross-sectional study involving 260 participants; 130 newly diagnosed and 130 HIV-negative controls aged 18 to 50 years from two centers in Port Harcourt from July, 2018 to January, 2019. Participants were clerked and diagnostic pure tone audiometry was done. Results: The rate of hearing loss was observed with Pure Tone Audiometry to be higher (P-value = 0.001) among newly diagnosed HAART naive adult patients 37 (28.5%) in comparison to the control 8 (6.2%). The mean age of all the study participants was 31.80 ± 9.61 years (study group 32.18 ± 10.18 years, control group 31.42 ± 9.12 years). Gender characteristic of participants also showed that males were 46 (35.4%) and females 84 (64.6%) giving a male, female ratio of 1:1.83 among newly diagnosed HAART naive adults, while among the control group there were males 49 (37.7%) and female 81 (62.3%) giving male: female ratio of 1:1.65. The rate of hearing loss at baseline was significantly (P = 0.001) higher among 37 HIV-positive HAART naïve patients (28.5%) compared with 8 control patients (6.2%). Conclusion: There was significant proportion of hearing loss among newly diagnosed HAART naive adult patients in Port Harcourt.
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The comparison of del nido cardioplegia and crystalloid-based blood cardioplegia in adult isolated coronary bypass surgery: A randomized controlled trial p. 1998
D Demir, AB Balci, N Kahraman, SA Sunbul, A Gucu, IB Seker, S Badem, A Yuksel, AF Ozyazicioglu, MT Goncu
DOI:10.4103/njcp.njcp_435_22  
Background and Aim: In our study, patients who underwent isolated coronary artery bypass surgery (CABG) using Del Nido cardioplegia (DNC) and crystalloid-based cold blood cardioplegia (CBC) were compared. Subject and Methods: In this study, two groups of patients who underwent isolated CABG using DNC (n = 106) and CBC (n = 107) were prospectively randomized. Groups were compared in terms of many results such as troponin T, returning spontaneous rhythm, and cardioplegia volume. Results and Conclusions: Median troponin T levels of the DNC and CBC groups were compared for the 0th hour (baseline), 12th, 36th, and 60th hours. There was no statistical difference between groups in troponin T levels of the baseline 0th hour (18[33] vs. 22[27] pg/ml; P = 0.724). Troponin T levels at the 12th hour were less in the DNC group than the CBC group but no statistical difference between the groups (790[735] vs. 826[820] pg/ml; P = 0.068), respectively. Troponin T levels at 36th and 60th hours were higher in the CBC group compared to the DNC group, and a statistical difference was observed (580[546] vs. 650[550] pg/ml; P = 0.030) and (359[395] vs. 421[400] pg/ml; P = 0.020), respectively. After X-clamping, the spontaneous rhythm rate was statistically higher in the DNC group than the CBC group (72.60% vs. 37.40%; P < 0.001). There was no statistical difference between the groups in terms of postoperative arrhythmia, hospital stay, and mortality rates (P > 0.05). Based on data we acquired from the study, we think that DNC is at least as safe and effective as CBC in adult CABG cases.
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Determination and comparison of potential drug–drug interactions using three different databases in northern cyprus community pharmacies p. 2005
ZN Alkhalid, N Birand
DOI:10.4103/njcp.njcp_448_22  
Background: Drug interactions are common drug-related problems that can lead to adverse drug reactions and hospitalization. Aims: The objectives of the study were to determine the potential drug–drug interactions (pDDIs) in Northern Cyprus community pharmacies and to compare three electronic databases regarding the frequency, mechanism, and severity of drug–drug interactions. Material and Methods: A retrospective observational study was conducted between July 1 and September 30, 2021, in Northern Cyprus community pharmacies using the Drugs.com, Lexicomp, and Medscape databases. The Mann–Whitney U-test was used to determine the difference between the values of the databases. Pearson's correlation was used to determine the association between DDIs and polypharmacy. Results: A total of 558 (52.1%) of 1072 prescriptions were included in the study. Drugs.com, Lexicomp, and Medscape databases detected 185, 176, and 213 potential drug–drug interactions in patients' prescriptions, respectively. There was a statistically significant difference in moderate drug interactions between the Medscape and Lexicomp databases (p = 0.02). Pearson's correlation showed a weak association (Medscape: r = 0.296, Lexicomp: r = 0.341, Drugs.com: r = 0.289, P = 0.0001) between pDDIs and polypharmacy. The assessment of agreement on severity of pDDIs characterized by Drugs.com and Lexicomp databases using the Kappa index was moderate agreement (0.509, P = 0.0001), while Drugs.com and Medscape databases using the Kappa index were moderate agreement (0.442, P = 0.0001), and Lexicomp and Medscape databases using the Kappa index were fair agreement (0.365, P = 0.0001). Conclusions: This study showed that Medscape detected more potential DDIs than Drugs.com and Lexicomp. Therefore, we propose that more than one database should be used to evaluate and identify pDDIs in pharmacy.
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Comparison of apical debris extrusion of different generation nickel-titanium instrument systems p. 2010
AD Uygun
DOI:10.4103/njcp.njcp_455_22  
Background and Aim: The aim of this study is to evaluate the apical debris extrusion amounts and preparation times of four different nickel-titanium systems with a similar cross-section design—Mtwo, RECIPROC, RECIPROC blue, and VDW.ROTATE. Materials and Methods: Eighty human mandibular central incisors were divided into four equal groups (n = 20). The test apparatus was inserted into an assembly that provided root canal temperature. Preparation times were recorded using a stopwatch, and the amount of extruded debris was collected in pre-weighed Eppendorf tubes. After drying, the net amount was determined by subtracting the previously measured Eppendorf tube weights from the total weight. Results: The Mtwo had the largest amount of debris, but there was no significant difference among the other groups. The VDW.ROTATE completed the preparation in a significantly shorter time than the RECIPROC blue and Mtwo. Conclusion: Compared to other files, the Mtwo sequence produced significantly more debris and required significantly more time to complete the whole root canal preparation.
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Risk factors for brachial plexus injury and permanent sequelae due to shoulder dystocia p. 2016
B Elmas, N Ercan, DT Ersak, EU Ozdemir, IH Çelik, OL Tapisiz, A Akay, E Yucel, M Armangil, OM Tekin
DOI:10.4103/njcp.njcp_464_22  
Aim: The primary aim of this study was to determine the risk factors for the occurrence of brachial plexus injury in cases of shoulder dystocia. Secondly, it was aimed to determine the factors affecting the occurrence of permanent sequelae in cases with brachial plexus injury. Subjects and Methods: ICD-10 codes were scanned from the records of patients who gave birth between 2012 and 2018, and the records of patients with brachial plexus injury and shoulder dystocia were reached. Shoulder dystocia cases with brachial plexus damage were accepted as the study group, and shoulder dystocia cases without brachial plexus damage were considered the control group. Shoulder dystocia patients with brachial plexus injury and without injury were compared for 2-year orthopedics clinic follow-up reports, surgical intervention, permanent sequelae status as well as birth data, maternal characteristics, and maneuvers applied to the management of shoulder dystocia. Results: Five hundred sixty births with shoulder dystocia were detected. Brachial plexus injury was observed in 88 of them, and permanent sequelae were detected in 12 of these patients. Maneuvers other than McRobert's (advanced maneuvers) were used more and clavicle fracture was seen more in the group with plexus injury (P < 0.05, P < 0.05, respectively). Logistic regression analysis was performed to determine the risk factors of brachial plexus injury. Brachial plexus injury was observed 4.746 times more in infants who were delivered with advanced maneuvers and 3.58 times more in infants with clavicle fractures at birth. Conclusion: In patients with shoulder dystocia, the risk of brachial plexus injury increased in deliveries in which advanced maneuvers were used and clavicle fracture occurred.
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Evaluation of the effect of anodization-colored titanium abutments and zirconia substructure thickness on zirconia substructure color: An In vitro study p. 2024
BB Bas, U Cakan
DOI:10.4103/njcp.njcp_484_22  
Background and Aim: The aim of this study is to evaluate the effect of anodized titanium abutments and zirconia substructure thickness on the color of zirconia substructure. Materials and Methods: In this study, an electrochemical anodization setup was prepared for titanium coloring. Commercial titanium, anodization-colored yellow and pink titanium, and zirconia were used as different abutment specimens. Thirty zirconia discs in 0.7, 0.9, and 1.1 mm thickness were prepared from zirconia blocks as zirconia substructure specimens (n = 10). Zirconia substructure specimens of different thicknesses were placed on abutment specimens of different colors and L*, a*, b* values were measured with a spectrophotometer device. Color difference (ΔE) was calculated according to the CIELab formula by comparing the L*, a*, and b* values obtained on the zirconia abutment with the L*, a*, and b* values obtained on the other abutments. Statistical analyzes were performed with two-way analysis of variance and Tukey Honestly Significant Difference (HSD)test (p < 0.05). Results: The increase in the thickness of the substructure resulted in a statistically significant difference on ΔE, L*, a*, and b* values (p < 0.001). The effect of abutment color had no significant effect on ΔE values. The highest ΔE value was 18.10 at zirconia substructure with 0.7 mm thickness when paired with pink-anodized titanium abutment specimens. Conclusion: The thickness of zirconia substructure and the color of titanium abutments affect zirconia substructure color.
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Stakeholders' perspectives on internal accountability within a sub-national immunization program: A qualitative study in Enugu State, South-East Nigeria p. 2030
DC Ogbuabor, N Ghasi, N Nwangwu, UJ Okenwa, U Ezenwaka, O Onwujekwe
DOI:10.4103/njcp.njcp_522_22  
Background: Weak accountability hinders the effectiveness of routine immunization (RI) systems in low- and middle-income countries, yet studies on accountability of immunization programs are scarce. Aim: The study explored stakeholders' perspectives on the functioning of internal accountability within the National Program on Immunization in Enugu State, southeast Nigeria. Subjects and Methods: We used semi-structured in-depth interviews to collect data from RI officials at state government, local government, and health facility levels (n = 35) in Enugu State between June and July 2021. We adopted maximum variation sampling to purposively select individuals with roles in immunization. The interview guide was developed based on an accountability framework with three dimensions—the axes of power, ability, and justice. Data were analyzed thematically using NVivo software (version 11). The major themes were role clarity, performance standards, supervision, data use, human resources, funding, motivation, sanctions, political influence, and community engagement. Results: Performance targets for immunization coverage and reporting timeline were not always met due to multiple accountability failures. Weaknesses in the formal rules that distribute roles among the immunization workforce comprise a lack of deployment letters, unavailability of job descriptions, and inadequate staff orientation. Local officials have a narrow decision space regarding staff posting, transfer, and discipline. Performance accountability was constrained by staff shortages, uneven staff distribution, absenteeism, infrequent supervision, weak data monitoring system, and underfunding. Despite being motivated by job recognition and accomplishments, low motivation from an insecure working environment and lack of financial incentives undermined the constructive agency of service delivery actors. The sanctions framework exists but is weakly enforced due to fear of victimization. Political commitment to the immunization program was low. Yet, political decision-makers interfered with staff recruitment, distribution, and discipline. Community engagement improved resource availability through paid volunteer health workers and maintenance of facilities. However, health facility committees were poorly resourced, non-functional, and lacked the power to sanction erring health workers. Conclusions: Immunization service delivery actors can be held accountable for program performance when there are sufficient formal instruments that provide roles and responsibilities, needed resources, motivated and supervised staff, an effective sanctions framework, genuine political participation, and strong community engagement.
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Does smoking affect the onset time of sensory blocks or the duration of motor blocks in parturient women? A randomized controlled trial p. 2039
HY Gunes, DK Caliskan, HA Sakar, N Yuzkat
DOI:10.4103/njcp.njcp_527_22  
Background: In general, smoking or exposure to secondhand smoke is still common worldwide, and the rate of smoking in women of childbearing age is gradually increasing. Cesarean section rates have been increasing in recent years, and anesthesia guidelines recommend regional anesthesia for cesarean sections. Since nicotine and local anesthetics have different effects on ligand-gated ion channels, smoking may affect spinal anesthesia in pregnant women. Aim: The aim of this study was to investigate the effects of smoking on spinal anesthesia, which is applied for cesarean sections in pregnant women. Patients and Methods: After approval from the institution's ethics committee, 100 pregnant women were divided into two groups: current smokers (Group S, smoker) (n = 50) and lifelong nonsmokers (Group NS, nonsmoker) (n = 50). The dose of local anesthetic was adjusted according to the height of each patient. After free cerebrospinal fluid flow was observed, all patients were given 20 μμg of fentanyl in 0.05 mg/cm hyperbaric 0.5% bupivacaine within 10 seconds. The onset of sensory and motor block, the duration of sensory and motor block, and the visual analogue scale (VAS) score were monitored. Results: Data from 100 parturient women were investigated. Even though the median time required for the onset of sensory block to occur was significantly higher in Group S (P = 0.019), the duration of motor block was found to be shorter (P = 0.003); however, the duration of sensory block was similar in both groups (P = 0.771). VAS scores were significantly higher in Group S (P = 0.001). Conclusions: In conclusion, the pregnant women who smoked had longer motor block onset times, shorter motor block durations, higher VAS scores, and lower patient satisfaction levels.
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Effectiveness of selective laser trabeculoplasty and its safety on corneal endothelium in patients with primary open angle glaucoma and ocular hypertension p. 2046
Sansal Gedik, Onur Gulseren
DOI:10.4103/njcp.njcp_560_22  
Background and Aim: The aim of this study was to evaluate the effectiveness of selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT), and to assess its effects and safety on corneal endothelial cell morphology. Patients and Methods: Forty patients with POAG (15 cases, 23 eyes) and OHT (25 cases, 48 eyes) were prospectively evaluated. All cases underwent pachymetry, goniolens examination, Humphrey Visual Field Test, Optical Coherence Tomography, and Corneal Confocal Microscopy measurements. Patients whose intraocular pressure (IOP) was more than 21 mmHg in POAG and OHT, underwent SLT. SLT treatment was applied to the inferior 180° region of the trabecular meshwork. Central corneal thickness (CCT), IOP, and specular microscopy examinations were taken at the visits before and after the first day, first week, first month, third and sixth months of the SLT procedure. Retinal nerve fiber layer (RNFL) thickness measurements and visual field tests were performed before and six month post-SLT. Results of the pre-SLT and post-SLT measurements were compared and a P value of lower than 0.05 was considered statistically significant. Results: The results of IOP measurements at first week, first month, third, and sixth month post-SLT were significantly lower than the results before and post-SLT first day. No significant difference was found between the results of initial and final measurements of CCT and specular microscopic corneal endothelial cell morphology evaluation. There was no statistically significant difference between the results of initial and final measurements for RNFL thickness and the results of the visual field tests. Conclusion: SLT is an effective treatment modality for reducing IOP in patients with POAG and OHT and is also a safe procedure in terms of the entirety of corneal endothelial cell morphology.
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Perceived satisfaction and outcomes from drug information center services provided with a telehealth approach p. 2053
GN Alhassan, AS Bosnak, E Hamurtekin
DOI:10.4103/njcp.njcp_552_22  
Background and Aim: Telehealth expansion is dependent on the acceptance and satisfaction of the providers and users of the telehealth service and the impact on the overall health-care system. This study was conducted to evaluate the outcome of pharmacist-led telehealth services and satisfaction of their users. Materials and Methods: The telehealth-based drug information center service was an 8-month retrospective, descriptive study that evaluated users' service satisfaction (quality of service), general health outcomes, recommendations, and personal health outcomes by electronically distributing a questionnaire to the users using a Donabedian model approach. Results: The feedback response rate was 87.33% (N = 131). The majority of users were 25–34-year-old young adults, while regarding the background status of the enquirers (health-care worker, medical doctor, nurse, patient, phar macist, practitioner/scientist), 35 (26.7%) pharmacists and 34 (26.0%) patients were the most prevalent users. In terms of service satisfaction and health outcome, medical doctors had the highest mean ratings of 4.67 ± 0.76 and 4.95 ± 0.21, respectively. Evaluation of the pharmacist-led telehealth impact was measured with four variables, which showed a statistical significance of P < 0.001 and a highly positive mean rating generally (service satisfaction 4.44 ± 0.83, general health outcome 4.54 ± 0.85, personal health outcome 4.80 ± 0.58, and recommendation 4.85 ± 0.43). The findings also showed that user satisfaction significantly impacted on personal health outcomes (P < 0.001), and that there was an insignificant relationship between user background status and continents. Conclusions: The study reveals the significant impact of pharmacist-led telehealth services and the importance of incorporating telehealth services into drug information centers.
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CASE REPORTS Top

Two cases of fetal inguinoscrotal hernia and review of the literature p. 2062
L Chen, J Wang, Q Yue, H Wen
DOI:10.4103/njcp.njcp_75_22  
Fetal inguinal hernia is quite rare and here we report two cases of prenatally diagnosed inguinoscrotal hernia to add to the limited understanding of this rare condition. The disappearance of blood flow signal in the scrotum may be helpful in detecting fetal incarcerated inguinoscrotal hernia that may progress to strangulation. If bowel dilatation was observed in such cases, the physician should be alert to identify primary intestinal obstruction caused by congenital digestive tract malformation and secondary intestinal obstruction caused by incarceration.
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Immediate flapless implant placement in a smoker patient: A challenge for optimum aesthetics and secondary stability: A case report p. 2067
A Aradya, R Chowdhary, S Srinivas
DOI:10.4103/njcp.njcp_106_22  
The objective of this case report was to restore the young patient with missing teeth and extruded tooth using an immediate implant and synthetic bone graft material for the esthetic and comfort purpose. A 21-year young man reported extrusion of a tooth as well as missing teeth. Clinical examination revealed missing teeth in relation to (irt) 11 and 21, extrusion of tooth in relation to (irt) 12, patient had generalized fluorosis, and localized marginal gingivitis with melanin pigmentation. The patient is a known smoker, and he was advised the cessation of smoking before the treatment. This paper describes a step-by-step approach to different treatment phases, starting with surgical guide fabrication, immediate implant surgical procedures, bone grafting procedure, and later prosthesis fabrication. Follow-up resulted in a satisfactory outcome.
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A successful reconstruction of the upper antihelix defect via postauricular pull-through pedicle flap p. 2073
T Maciulaitis, R Venciute-Stankevice, N Jakutis
DOI:10.4103/njcp.njcp_416_22  
The auricle is a complex anatomic structure with a three-dimensional configuration proper reinstating that poses a substantial reconstructive challenge. The postauricular pull-through flap is perfectly suitable method for the reconstruction of helical and antihelical auricle defects; however, due to its difficult harvest technique, it is not commonly used in a practice. Here we describe a case of a patient with an antihelix defect following basal cell carcinoma (BCC). In our case, the reconstruction was performed via postauricular pull-through pedicle flap, and a satisfactory result was achieved.
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Identification of a novel mutation in ALMS1 in a Chinese patient with monogenic diabetic syndrome by whole-exome sequencing p. 2077
Ming Zhong, Ling-Ning Huang, Song-Jing Zhang, Sun-Jie Yan
DOI:10.4103/njcp.njcp_544_22  
Alstrom syndrome (AS) is one type of monogenic diabetic syndromes caused by mutation in the ALMS1. Due to rare prevalence and overlaps of clinical symptoms, monogenic diabetes is often misdiagnosed. Here, we report a Chinese diabetes patient with poor blood glucose control and insulin resistance. With whole-exome sequencing (WES), this patient was classified into monogenic diabetes and diagnosed as AS with one novel gene mutation identified. This study highlights the clinical application of WES in the diagnosis of monogenic diabetes.
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LETTER TO EDITOR Top

Body composition imaging, clinicopathological status, and genetic profile in clear cell renal cell carcinoma p. 2081
F Greco, B Beomonte Zobel, CA Mallio
DOI:10.4103/njcp.njcp_80_22  
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