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   Table of Contents - Current issue
September 2022
Volume 25 | Issue 9
Page Nos. 1387-1614

Online since Thursday, September 22, 2022

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Differences in SUV39H1 and androgen receptor distribution in adenomyomatous hyperplasia and prostatic adenocarcinoma p. 1387
M Akcay Celik, H Erdem, S Cankaya, Y Kasko Arici
DOI:10.4103/njcp.njcp_61_20  PMID:36149194
Background: Androgen receptor (AR) contributes to the growth of both early- and late-stage prostate cancer. Overexpression of suppressor of variegation 3-9 homolog 1 (SUV39H1) increases migration of prostate cancer cells, while depletion of SUV39H1 suppresses migration of prostate cancer cells. Aim: In this study, the aim was to show the relationships of AR and SUV39H1 with adenomyomatous hyperplasia (AH) and prostate adenocarcinoma (PCa). Materials and Methods: 70 AH and 70 PCa preparations in Pathology Department from 2013 to 16 were retrospectively investigated. Samples with immunohistochemical staining for AR and SUV39H1 were evaluated with a light microscope. After pathologic investigation of samples, AR and SUV39H1 expressions were scored. The changes in the frequencies of the obtained scores in the AH and PCa groups were analyzed statistically. Results: AR expression was observed to be greater in AH compared to PCa. This difference was found to be statistically significant (p = 0.003). SUV39H1 expression was identified to be greater in PCa compared to AH and this showed statistical significance (p = 0.031). PCa samples were identified to have nearly 1.5 times more SUV39H1 mild staining compared to AH samples and this increase was two times for SUV39H1 strong staining. Conclusion: In our study, AR expression was greater in AH compared to PCa samples. This situation is inverse to the known mechanism and cannot be clearly explained. It needs to be supported with large series and other prognostic parameters. This study observed increased SUV39H1 values in PCa compared to AH and from this aspect, it may be considered an important poor prognosis parameter.
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Determination of the level of von willebrand factor and ADAMTS13 in sickle cell anaemia patients in steady state p. 1393
Akaba Kingsley, Essien Ofonime, Uboh Enobong, Ibanga Iquo
DOI:10.4103/njcp.njcp_110_21  PMID:36149195
Background: Sickle cell anaemia (SCA) is a hypercoagulable state with alteration in the haemostatic parameters and may contribute to thrombosis in a steady state. The levels of von Willebrand factor (VWF) and ADAMTS13 antigen in the steady state as markers of thrombotic risk have not been fully investigated in our environment. Aim: Evaluation of the level of VWF and ADAMTS13 as a marker of thrombotic risk in SCA subjects in the steady state at UCTH, Calabar. Subjects and Methods: This is a comparative study carried out at UCTH, Calabar. Sixty SCA patients were evaluated in the steady state with apparently healthy controls matched for age and sex VWF.Ag, and ADAMTS13.Ag was evaluated using Assay Pro enzyme-linked immunosorbent assay kit. Data was analysed with IBM Statistical Package for Social Sciences Chicago Software version 26. Results: The median age of SCA and controls were 23 years and 20 years, respectively (P = 0.962). There were no significant differences in their sex distribution (P = 0.063). The mean ± standard deviation (SD) of VWF in the steady state and control were 1.34 ± 0.23 IU/mL and 1.41 ± 0.23 IU/mL with no significant difference in their mean (P = 0.864). The mean ± SD of ADAMTS13 in the steady state and control were 0.44 ± 0.06 μg/L and 0.62 ± 0.10 μg/L, respectively, with no significant difference in their mean (P = 0.171). Conclusion: There was no significant difference between VWF.Ag, ADAMTS13, and VWF.Ag: ADAMTS13 antigen ratio in SCA in the steady state and control. There is a need for further research to determine their functionality.
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Effect of delta carbon dioxide and lactate on prognosis in patients undergoing open-heart surgery p. 1398
H Akca, HS Akca, N Yapici
DOI:10.4103/njcp.njcp_1328_21  PMID:36149196
Background: To identify individuals with an increased mortality and morbidity risk after surgery, different parameters showing impaired tissue perfusion/oxygenation have been investigated, and the balance between tissue oxygen consumption and oxygen delivery has been evaluated in detecting organ failure. Aim: This study aimed to evaluate the efficacy of central venous–-arterial partial carbon dioxide difference (ΔPCO2) and lactate (ΔLAC) values within the first week after discharge in predicting mortality in patients undergoing open-heart surgery. Patients and Methods: A total of 102 patients between February and April 2020 were included in the study. The patients' data obtained at the end of cardiopulmonary bypass (hour 0) and during the intensive care follow-up (hour 1, hours 6, and 24) data were prospectively recorded. All statistical analyses were performed using SPSS v. 22.0 for Windows (SPSS Inc, Chicago, IL, USA). Results: The mean age of the patients was 56.88 ± 11.02 (min 18–max 78) years, and 71.6% of the patients were male. It was observed that the area under the curve was not significant for the four measurements performed for ΔLAC. Although the area under the curve of ΔPCO2 measured at hour 6 (0.66) was significant. Conclusion: The ΔPCO2 were found to have a poor ability to predict the development of complications during the intensive care and early postoperative period in patients undergoing open-heart surgery.
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Serum immunoglobulins, C-reactive protein, and trace element level in preeclamptic Nigerian subjects p. 1405
AJ Nwatah, GO Ugwu, CE Ugwu, SC Meludu
DOI:10.4103/njcp.njcp_1455_21  PMID:36149197
Background: The mechanism involved in the pathogenesis of preeclampsia (PE) remains uncertain, and the research into a better understanding, its possible prediction, and subsequent prevention continues. Aim: This study evaluated changes in serum immunoglobulins (IgG, IgA, and IgM), C-reactive protein, and trace elements (Zn, Cu, and Mn) in preeclamptic, normotensive pregnant, and non-pregnant females. Subjects and Methods: The study was conducted among 150 subjects consisting of 50 preeclamptic subjects, 50 healthy normotensive pregnant women in their third trimester, and 50 non-pregnant women, all within the same age bracket. The serum concentration of the immunoglobulins and C-reactive protein were measured using standard immunoturbidimetric methods, whereas the trace elements were assayed using the atomic absorption spectrophotometric method. Results: Serum IgG and IgM levels were observed to be significantly lower (P < 0.05) in preeclamptic subjects (101.22 ± 4.44 and 769.43 ± 1.43 mg/dl), respectively, when compared to the normotensive pregnant women (123.87 ± 1.81 and 881.71 ± 2.80 mg/dl), respectively. There was a non-significant difference in immunoglobulin A levels between the groups (P > 0.05). The C-reactive protein was significantly higher, whereas the trace elements were significantly lower (P < 0.05) in preeclamptic subjects compared to the normotensives. There was a positive correlation between the immunoglobulin G and Zn levels (r = 0.334; P = 0.046) and also between immunoglobulin G and C-reactive protein levels (r = 0.340; P = 0.043) and a negative correlation between systolic blood pressure and manganese levels in preeclamptic subjects (r = −0.375; P = 0.024). Conclusion: This study therefore reveals significantly lower levels of immunoglobulins and trace elements among the preeclamptic subjects. These micronutrient deficiencies and low levels of immunoglobulins could be risk factors for the development of high blood pressure and PE.
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Incidence and causes of early hospital readmissions after living donor renal transplant – A single centre study p. 1413
A Sharma, A Bhardwaj, RP Mathur
DOI:10.4103/njcp.njcp_1524_21  PMID:36149198
Background: Kidney transplantation in spite of being the best modality for the treatment of ESRD remains a complex therapeutic option as it has its own set of problems due to associated morbidity especially in the first month after transplantation. Aim: The primary aim of this study was to find the incidence, causes, and factors responsible for early hospital readmissions (EHRs) and secondary aim was to find the effect of EHR on morbidity, mortality, and graft loss. Patients and Methods: A retrospective analysis of the records of the chronic kidney disease (CKD) patients who underwent living donor renal transplantation. 202 patients were included in the study. Inpatient records and charts were assessed for the medical status of the patients, cause of CKD, comorbidities, admissions 3 months prior to transplant, vintage dialysis, and modality of dialysis. Results: Sixty-one (30.2%) patients were readmitted to the hospital once or more within 30 days of discharge after renal transplantation. Thirty-four (55.7%) patients in the EHR group were admitted once or more in the 90 days prior to transplant as compared to 48 (34%) patients in the no readmission group. Thirty-four (55.7%) patients in the EHR group were hospitalised again within 1 year of EHR and 50 (35.5%) in the no EHR group got admitted within 1 year of discharge. Conclusions: Renal transplant recipients with hospital admissions 90 days before transplant and readmissions within 30 days of discharge after transplantation are at high risk of morbidity and should be treated as high-risk category and should have more stringent follow-up protocols.
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A novel combined index of D-dimer, fibrinogen, albumin, and platelet (FDAPR) as mortality predictor of COVID-19 p. 1418
A Celikkol, M Dogan, EC Guzel, B Erdal, A Yilmaz
DOI:10.4103/njcp.njcp_1633_21  PMID:36149199
Background: In coronavirus disease 2019 (COVID-19) caused by SARSCoV2 viruses, coagulation abnormalities are strongly correlated between disease severity and mortality risk. Aims: The aim was to search for new indices to determine mortality risk. Fibrinogen times D-dimer to albumin times platelet ratio calculated with the formula (FDAPR index: ((Fibrinogen × D-dimer)/(Albumin × Platelet)) investigated as a mortality marker in COVID-19 patients. The hospitalization data of 1124 patients were analyzed from the electronic archive system. Hemogram, coagulation, and inflammatory markers were investigated in the study group. Materials and Methods: All statistical analyses like the student t-test, Mann–Whitney U, Kaplan–Meier, and Cox hazard ratio, were performed with the SPSS 22.0 program. Results: Prothrombin time was prolonged significantly in patients (P < 0.05) compared to healthy subjects (n = 30). D-dimer and fibrinogen were high, and albumin and platelet counts were low in COVID-19 patients (all, P < 0.001). When the data of 224 non-survivors and 900 survived patients were compared, D-dimer and fibrinogen were higher, and albumin and platelet lower (all, P < 0.001) compared to mild and severe patients. At the cut-off value of 0.49, the FDAPR index was performed with 89.1% sensitivity and 88.6% specificity. FDAPR index had the highest mortality predictive power (P < 0.01; HR = 5.366; 95% CI; 1.729–16.654). Conclusions: This study revealed that the FDAPR index could be used as a mortality marker of COVID-19 disease.
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Ki-67, p-53, E-Cadherin, and β-Catenin expression of advanced glotto-subglottic and supraglottic larynx carcinomas p. 1424
A Kara, G Turan, M Guven, EM Guven, H Elden
DOI:10.4103/njcp.njcp_1693_21  PMID:36149200
Background: Identifying tumor markers that can be used to determine the biological behavior of tumors and predicting their prognosis may be helpful in choosing treatment strategies. Besides the differences in the embryological and histological anatomy of the larynx in this regard, the possibility of molecular causes that can explain the different clinical behaviors has always been a question for the scientific world. Aim: In this study, we aimed to investigate whether there were any immunohistochemically molecular differences among laryngeal carcinoma cases originating from two different anatomical regions of the larynx. Patients and Methods: The study group consisted of 43 patients. The rate of supraglottic cancers was 41.8%, while the rest had glotto-subglottic tumors. Ki67, β-catenin, E-cadherin, and p53 were examined in pathology preparations obtained by laryngectomy surgeries. The data obtained were analyzed by comparing factors that may affect the prognosis of the disease and between tumors originating from the two different anatomical regions. Results: We did not see any statistically significant difference between groups for stage and grade of tumor, tumor recurrence rate, or lymphovascular or perineural invasion rated in terms of the investigated markers. In addition, there was no statistically significant difference between the two distinct groups in survival analysis. Conclusions: With these results, our study differs from some studies in the literature, and we think that this difference could be because the cases in our study consisted of advanced stage tumors and the groups investigated had similar survival rates.
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Distribution of ocular perfusion pressure and its relationship with intraocular pressure in patients with primary open angle glaucoma in Enugu, South East, Nigeria p. 1430
IC Arinze, SN Onwubiko, NZ Nwachukwu, FC Maduka-Okafor, AE Aghaji, MO Nkwegu, EN Onwasigwe
DOI:10.4103/njcp.njcp_1813_21  PMID:36149201
Background: Ocular perfusion pressure (OPP) has been suggested as a possible risk factor for the development and progression of primary open angle glaucoma (POAG). Aim: To determine the distribution of OPP and its relationship with intraocular pressure (IOP) in Nigerian patients with POAG. Patients and Methods: A descriptive and comparative survey was adopted. A total of 120 subjects, 60 newly diagnosed POAG and 60 non-glaucomatous (NG) subjects, aged 40 years and above, who attended the ophthalmic clinic of University of Nigeria Teaching Hospital Enugu were recruited over a six-month period in 2019. All the subjects had ocular examination, blood pressure and IOP measurements. Statistical package for social sciences software version 25 was used for data analysis. Chi-square test, independent samples t-test, and Mann-Whitney U test were used for comparison while Pearson correlation and simple linear regression were used to ascertain the relationship. A P value of <0.05 was considered significant. Result: The mean age of the participants was 57.9 + 11.9 years. The mean OPP was found to be significantly lower in the POAG subjects (Right eye, R = 43.6 ± 12.6, Left eye, L = 41.9 ± 13.3) mmHg compared with the NG group (R = 53.9 ± 10.9, L = 53.7 ± 10.9) mmHg (p < 0.001 for both eyes). A significant inverse relationship was observed between OPP and IOP in POAG subjects (p < 0.001), while there was none in NG subjects. Conclusion: OPP was lower in POAG subjects than in NG subjects. The observed relationship suggests that reduced OPP may play a role in the development of POAG.
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The comparison of anxiety and depression levels of resident doctors treating and not treating COVID-19 patients p. 1435
Aslihan Esra Yuksel, Akin Tahillioglu, Sibel Durak, Seyda Ceylan Ari, Kazim Koray Ozgul, Eyup Sabri Ercan
DOI:10.4103/njcp.njcp_1853_21  PMID:36149202
Background: Healthcare professionals are exposed to the stress of the pandemic in the highest level and try to cope with the long-term psychological consequences. Aim: This study mainly aimed to compare the anxiety and depression levels of resident doctors (RDs) who cared and did not care for coronavirus disease 2019 (COVID-19) patients at the University Hospital, which has been serving as a pandemic hospital during the COVID-19 outbreak. Subjects and Methods: To proceed with this study, 100 RDs were included this study between March 15 and June 1, 2020. Patient Health Questionnaire (PHQ-9) was used to measure the depression levels and the Beck Anxiety Inventory (BAI) was used to measure the anxiety levels of the RDs who participated in the study. Results: The analysis of the responses showed that there were 49 RDs treating COVID-19 patients and 51 RDs not treating COVID-19 patients. The proportions of the RDs who had higher PHQ-9 and BAI scores were significantly greater in the RDs treating COVID-19 patients than in those not treating. Conclusion: Our study highlights that front-line RDs have higher levels of anxiety and depression than back-line RDs
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Effects of total knee arthroplasty on balance and fall risk in elderly patients with severe gonarthrosis: An age- and sex-matched comparative study p. 1445
S Sargin, NS Guler, N Sahin, A Aslan
DOI:10.4103/njcp.njcp_1856_21  PMID:36149203
Background: Falls are a severe cause of morbidity and mortality in elderly patients, and gonarthrosis causes a tendency to fall. Total knee arthroplasty (TKA) is a widely used successful surgical procedure for end-stage gonarthrosis. Aims: To investigate whether there is a difference in the frequency of falls, balance and fall risk, and clinical and radiological results in patients with end-stage gonarthrosis with and without TKA. Patients and Methods: This was a single-center, retrospective, case-control study with age- and gender-matched groups. A total of 100 patients over 60 years of age, with end-stage gonarthrosis and who met the inclusion criteria were included in the study. Fall risk was analyzed using the Berg Balance Scale (BBS), TUG tests, and the ITAKI Fall Risk Test. Knee varus angles were measured using standing long-leg radiographs, and radiological gonarthrosis grading was performed. Pain levels and quality of life were assessed using the VAS and WOMAC. Each patient's knee extensor muscle strength and range of motion were measured. Results: WOMAC, ITAKI, TUG test, and VAS scores were significantly higher in the control group than in the TKA group. BBS scores were significantly lower in the control group. Although the number of falls was high in the control group, there was no statistically significant difference between the two groups. Conclusion: The results of this study showed that total knee arthroplasty provided statistically significant improvement in the clinical, radiological, and fall risk results of the patients. Although there was a decrease in the frequency of falls compared to the control group, it was statistically insignificant. In addition, in our study, it was evaluated that the most important risk factor for falling was advanced age.
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Alteration of inflammation marker levels with alfa keto analogs in diabetic rats p. 1452
YD Bildaci, H Bulut, OC Elcioglu, M Gursu, R Kazancioglu
DOI:10.4103/njcp.njcp_1868_21  PMID:36149204
Background: Diabetes mellitus is the most well-known and common cause of end-stage renal disease. Excessive inflammatory processes were hypothesized to be one of the reasons for progression to end-stage disease. Even though progression to end stage disease tried to be prevented with some dietary measures such as lowering nitrogen in diet, none of the methods tried were successful enough. Aims: In our study, we aimed to determine the effects of alfa keto analog use in altering levels of inflammatory markers when added to dietary program in a diabetic rat model. Patients and Methods: The study was performed on 22 male Sprague Dawley rats with streptozocine induced diabetic nephropathy. Both groups were fed with low protein diet except for study group with added alfa keto analogs. Biochemical values and inflammatory markers were studied with ELISA assay. Results: Significant difference in serum albumin was found between study group and control group following administration of alfa keto analogs (p <.001). Also mentioned dietary modification made a significant difference in suppression of inflammatory reactions for interleukin (IL)-1, IL-6, IL-10, IL-18 and tumor necrosis factor-α. Conclusion: Adding keto amino acids to diets that are already low on protein, can slow progression to end-stage renal disease by reducing inflammation and protein loss in an animal model.
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Posterior quadratus lumborum block versus posterior transversus abdominis plane block for unilateral inguinal hernia surgery p. 1457
CO Caparlar, S Altinsoy, FK Akelma, MO Ozhan, J Ergil
DOI:10.4103/njcp.njcp_1876_21  PMID:36149205
Background: Ultrasound-guided truncal nerve blocks are increasingly used for postoperative pain relief after abdominal surgery. Aim: The aim of this prospective and randomized study was to compare posterior transversus abdominis plane block (pTAPB) with posterior quadratus lumborum block (pQLB) for postoperative analgesic efficacy in patients undergoing unilateral inguinal hernia surgery under general anesthesia (GA). Patients and Methods: A total of 90 adult patients were randomized into 3 groups: group pTAPB (n = 30), group pQLB (n = 30), and group Control (n = 30). The patients in groups pQLB and pTAPB received a unilateral block using 20 ml of 0.25% bupivacaine after the induction of GA. Intravenous (IV) tramadol patient control group analgesia (PCA) and paracetamol were used in the postoperative period as a part of the multimodal analgesic regimen in both groups. Postoperative pain was assessed using a visual analog scale (VAS) during postoperative 24 h. Dexketoprofene was used as a rescue analgesic when VAS is >3. The primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesics and the amount of tramadol delivered by PCA. P <0.05 was considered statistically significant. Results: Mean VAS scores were significantly lower in the group pQLB than group pTAPB and group Control at all-time points (pQLB < pTAPB < Control; P < 0.001). Rescue analgesic was not required in group QLB. Rescue analgesic consumption, the number of bolus demand on PCA, and total PCA dose were highest in group Control and lowest in the pQLB group (Control > pTAPB > pQLB; P < 0.001). Conclusion: It is concluded that both pQLB and pTAPB provided effective pain relief after unilateral inguinal hernia surgery. pQLB was superior to pTAPB due to lower pain scores and analgesic consumption.
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The antibacterial activity of nasturtium officinale extract on common oral pathogenic bacteria p. 1466
M Tabesh, M Etemadi Sh, M Etemadi, F Naddaf, F Heidari, J Alizargar
DOI:10.4103/njcp.njcp_1887_21  PMID:36149206
Background: The oral cavity is colonized by a myriad of microorganisms, some of which are proven to be detrimental to human health. There have been numerous efforts to control the population of pathogenic agents in the oral cavity, including the usage of natural phytochemicals obtained from medicinal plants. Nasturtium officinale has long been used in traditional medicine for the management of hypertension, respiratory infections, and hyperglycemia, and its effectiveness against some microbes has been reported. Aims: To evaluate antimicrobial properties of a hydro-alcoholic extract of N. officinale against common oral pathogens namely Streptococcus mutans, Staphylococcus aureus, Lactobacillus acidophilus, Enterococcus faecalis, and Pseudomonas aeruginosa. Experimental laboratory study. Different dilutions of N. officinale hydro-alcoholic extract were the test solutions, the positive control was a bacterial suspension in sterile phosphate-buffered saline, whereas the negative control was the herbal extract only, without any bacterial inoculation. Hydro-alcoholic extract of N. officinale prepared in five different concentrations (105, 52.5, 26.25, 13.12, 6.56 mg.mL-1) was tested separately against Streptococcus mutans, Lactobacillus acidophilus, Pseudomonas aeruginosa, Enterococcus faecalis, and Staphylococcus aureus in a test of microdilution assay. Spectrophotometry was used to assess bacterial growth after 24 and 48 h. Materials and Methods: The data of optical absorbance reads from spectrophotometry were analyzed using repeated-measures analysis followed by Least Significant Differences (LSD) post hoc. Results: The highest growth inhibitory effect against S. mutans, E. faecalis, and S. aureus was observed at a concentration of 13.12 mg.mL-1; for L. acidophilus and P. aeruginosa, the most significant inhibition was observed at a concentration of 105 mg.mL-1. Conclusion: N. officinale extract effectively inhibited the growth of the tested oral bacteria at different concentrations but was more effective against S. mutans, E. faecalis, and S. aureus and so may be effective in managing some oral microbial infections.
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Finite element analysis of optimal design of distal geometry of cementless femoral prosthesis p. 1476
Y Zhao, L Wang, Y Bao, R Xu, S He
DOI:10.4103/njcp.njcp_1888_21  PMID:36149207
Aim and Background: This study aims to improve the geometric design of the distal cementless femoral prosthesis stem, thereby changing the stress distribution of the femoral prosthesis and reducing the proximal stress shielding and distal stress concentration of the femur, so as to obtain better bone growth and long-term stability. Materials and Methods: Two geometric shapes of the femoral stems, namely, inverted hollow cone and cross-shaped bottom groove, are designed for the distal femoral prosthesis. The model is built based on the femoral computed tomography (CT) data of healthy volunteers, and the finite element method is used to analyze and calculate the stress distribution of the two femoral prosthesis stems. Results: According to the length and width of bottom “cross” groove, the stress values of the femoral region of the cross-grooved distal femur are divided into five groups, namely, group 1 (length 1:1, groove width 1.0 mm); group 2 (length 1:1, groove width 1.5 mm); group 3 (length 1:1, groove width 2.0 mm); group 4 (length 1:2, groove width 1.0 mm); group 5 (length 1:2, groove 1.5 mm wide). And the non-grooved group of the distal femur is designated as group 0. In the segment A, B, and C of the femoral region, the difference in the mean stress between group 0 and groups 1, 2, and 3 have statistical significance. Conclusion: The bottom “cross” groove of the distal femoral prosthesis can change the stress distribution in the prosthesis-distal femoral region and reduce the stress concentration at the distal prosthesis. Wherein, the grooved design of length ratio 1:1 is more advantageous.
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Effects chemical disinfectants on surface roughness of conventional impression materials used for dental prosthetic procedures p. 1484
E Altintas, A Rencber
DOI:10.4103/njcp.njcp_1920_21  PMID:36149208
Background to Aim: To compare the effects of disinfectants on surface roughness of the conventional impression materials following chemical disinfection procedures. Materials and Methods: Equal numbers (65 for each impression material) of disc-shaped (15 × 3 mm) samples (Total n = 195) were fabricated from polyvinyl siloxane (Zhermack Elite), polyether (3M Impregum Penta Soft), and vinyl siloxane ether (Kettenbach Identium Lightbody) impression materials. Each impression material group was divided into five subgroups including one control group (n = 13). Impression material samples were immersed in CaviCide for 3 min, Zeta 7 solution for 10 min, and 5.25% sodium hypochlorite solution for 3 and 10 min. Surface roughness (Ra) was measured using a profilometer (Mitutoyo-SJ 410, Mitutoyo Corp.). The study data were analyzed statistically. Results: A statistically significant difference was found among impression materials and disinfectants in terms of surface roughness (P < 0.05). Polyvinyl siloxane material showed a lower Ra value compared to Polyether and VSE materials; while polyether material showed a significantly lower Ra value compared to VSE material. Ra values of the control group were significantly lower than the disinfectant group immersed in 5.25% NaOCl solution for 10 min. Conclusion: Among all impression materials, polyvinyl siloxane showed the least surface roughness following disinfection procedures. Impression disinfectants that are specially designed for disinfecting dental impressions resulted in less surface roughness in all impression materials. With this study, it was aimed to obtain a smooth and clear model for the production of correct and compatible prostheses in the laboratory while at the same time purifying the impressions from microorganisms.
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Comparison of propofol-fentanyl and propofol-ketamine for sedoanalgesia in percutaneous endoscopic gastrostomy procedures p. 1490
M Duran, M Dogukan, M Tepe, K Ceyhan, M Sertkaya, O Uludag, N Yilmaz
DOI:10.4103/njcp.njcp_1953_21  PMID:36149209
Background: Percutaneous endoscopic gastrostomy (PEG) procedures are performed under sedation in critically ill patients who cannot be fed orally. Aim: We compared the efficacy and safety of propofol-fentanyl and propofol-ketamine for deep sedation in patients undergoing PEG. Retrospective Study. Materials and Methods: The study was conducted from 1 January 2013 to 31 December 2018 in Adıyaman University. The patients given propofol-fentanyl (0.5–1.2 mg/kg and 0.2–1 μg/kg, respectively) for sedo-analgesia were designated Group F, and those who received propofol-ketamine (0.2–0.6 mg/kg and 0.5–1 mg/kg, respectively) were placed in Group K. The demographic and hemodynamic characteristics, recovery times, perioperative complications, and need for additional doses were recorded. Results: Seventy-one patients who underwent PEG were analyzed. The age, sex, American Society of Anesthesiologists (ASA) score, comorbidities, duration of anesthesia, and duration of the PEG procedure were similar in the two groups. Recovery time was longer in Group K. The total propofol dose was 64 mg in Group F and 35 mg in Group K. Additional doses of propofol were administered to 12 patients in Group F, compared to none in Group K. The mean blood pressure values were higher in Group K at all-time points. The perioperative complication rate was higher in Group F. Desaturation was observed in 9 (22.5%) patients in Group F and in 3 (9.6%) patients in Group K. Hypotension was observed in 4 (10%) patients in Group F. Conclusion: Propofol-ketamine should be preferred for sedoanalgesia during PEG procedures because of the lower dose of propofol, more stable blood pressure, and greater peripheral oxygen saturation. In addition, we believe ketamine-propofol is safer based on its low complication rate.
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Evaluation of retinal and choroidal thicknesses in patients with diabetes mellitus without diabetic retinopathy: A comparative study p. 1495
HB Kapti, AK Sahin, O Ozdemir
DOI:10.4103/njcp.njcp_1960_21  PMID:36149210
Background: One of the most important complications of diabetes mellitus (DM) is vision loss due to diabetic retinopathy (DR). Optical coherence tomography (OCT) provides visualization of early structural abnormalities of the retina and choroid. Aim: To compare retinal thickness (RT) and choroidal thickness (CT) between patients with DM without DR and healthy controls. Patients and Methods: Diabetic patients without DR were divided into two groups according to serum glycosylated hemoglobin (HbA1c) levels. Group 1: HbA1c ≤7.5 (n = 25) and group 2: HbA1c >7.5 (n = 23). The 3rd group was the healthy control group (n = 25). CT and RT measured by OCT were compared between the three groups. Results: CT in the subfoveal, temporal, and nasal quadrants was significantly higher in the healthy control group than in groups 1 and 2. Subfoveal and temporal quadrant CT in group 2 were significantly thinner than those in group 1. The average RT (ART) was thinner in group 1 than in the other groups, but there was no difference between the control group and group 2. Conclusions: This study showed that CT and ART decreased in diabetic patients without DR.
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A comparison of peripheral blood smear microscopy and detection of histidine-rich protein 2 in blood in the diagnosis of malaria in pregnancy p. 1501
CE Mofon, PN Ebeigbe, EE Ijomone
DOI:10.4103/njcp.njcp_1962_21  PMID:36149211
Background: Detection of malaria in pregnancy poses a huge challenge in Sub-Saharan Africa. Accurate diagnosis enables timely and appropriate clinical management. Aims: This study aimed to compare the accuracy of peripheral venous blood smear microscopy (PVBSM) and a rapid diagnostic test detecting histidine-rich protein 2 in the blood (RDT-HRP2) with placental histology as the control in the diagnosis of malaria in pregnancy in Nigerian women. Materials and Methods: This was a comparative, cross-sectional study conducted between January and July 2017. Asymptomatic pregnant women who presented to the labor ward and who gave informed consent had peripheral venous blood samples as well as placental tissue obtained following delivery. The blood samples obtained were tested for malaria parasites using PVBSM and RDT-HRP2 in blood, while the placenta was subjected to histology. Results: A total of 326 patients participated in the study. The prevalence of malaria in pregnancy was 13.8%, 17.8%, and 32.8% using PVBSM, RDT-HRP2, and placental histology. The sensitivity, specificity, and accuracy of PVBSM were 40.2%, 99.1%, and 79.8% and the corresponding values for RDT-HRP2 were 49.5%, 97.7%, and 81.9%. The positive predictive value was 95.6% for PVBSM and 91.4% for RDT-HRP2 and the negative predictive value was 77.2% for PVBSM and 79.9% for RDT- HRP2. Conclusions: The diagnostic performances of both tests were comparable; however, RDT-HRP2 had a higher sensitivity and accuracy than PVBSM for the diagnosis of malaria in pregnancy.
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The caffeine consumption among Turkish pregnant women p. 1507
Elif Yagmur Gur, Mevra Aydin Cil, Serap Ejder Apay
DOI:10.4103/njcp.njcp_1983_21  PMID:36149212
Background: Caffeine consumption during pregnancy has effect on newborn anthropometry therefore the amount of maternal caffeine consumption is important. Aim: This study aims to determine caffeine consumption during pregnancy and related factors. Subjects and Methods: This study was carried out in a maternity hospital located in Eastern Turkey from September 2018 to June 2019 with 300 healthy primiparous women and babies. Data were collected by the researchers with a socio-demographic questionnaire and caffeine consumption frequency semi-quantitative questionnaire using the face-to-face interview technique. Postpartum weight and height of the women and length, weight, and head circumference of the newborns were measured. Evaluation of the data was carried out with Kruskal–Wallis and Mann–Whitney U test and binary logistic regression analysis was used for relationship analysis. Results: The mean daily caffeine intake of the pregnant women was determined as 344.9 ± 181.4 mg/day and 4.9 ± 2.6 mg/kg/day. The babies' mean birth weight was 2943.1 ± 407.4 g, mean length was 50.1 ± 2.2 cm, and mean head circumference was 32.3 ± 1.6 cm. A statistically significant negative correlation was found between caffeine consumption of pregnant women and newborn birth weight and length (P = 0.049; P = 0.007, respectively). After age, economic and educational status, and pre- and post-pregnancy BMI were corrected according to weight increase during pregnancy and after binary logistic regression analysis was performed, it was determined that caffeine consumption did not have an effect on low birth weight (Total caffeine consumption (mg/day), P = 0.669 OR = 1.00, 95% Cl = 0.997-1.002; caffeine consumption (mg/kg), P = 0.549 OR = 0.956, 95% Cl = 0.824-1.109). Conclusion: Caffeine consumption of pregnant women is higher than the recommended levels. Therefore, pregnant women should be informed about caffeine sources and consumption amounts.
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A novel scarless laparoscopic method for morgagni hernia repair p. 1517
MH Okur, B Aydogdu, M Azizoglu, S Arslan, E Basuguy
DOI:10.4103/njcp.njcp_36_22  PMID:36149213
Background: Morgagni hernia (MH) is a rare congenital defect of the diaphragm. Although the various surgical method has been proposed, there is no surgical consensus. Aim: In this study, we aimed to report the outcome of the patients that underwent surgery which is completed using a single port laparoscopic-assisted transabdominal closure of MH. Patients and Methods: This is a retrospective analysis of 18 pediatric patients who underwent novel laparoscopic MH repair at a single tertiary pediatric hospital between March 2018 and December 2020. Results: Of the 18 patients, 72% (n = 13) were male and 28% (n = 5) were female. The symptoms at admission included repeated chest infection (39%), dyspnea (33%), vomiting (17%), and abdominal pain (22%). The colon (78%) was the most frequently herniated organ. Hernias were bilateral, on the left, and on the right in seven, four, and seven cases, respectively. All surgical interventions were completed within 25–50 min. All patients started enteral feeding within 24 hours. All patients were discharged within 1–3 days without any complications. The mean follow-up period was 27 months. Conclusions: In conclusion, our method is characterized by a shorter operation time, early return to feeding, early discharge, excellent cosmetic results, low cost, and low recurrence rate. Further prospective trials are needed to compare our novel scarless technique to other methods.
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Correlation between prostate volume and prostate-specific antigen in Nigerian men with symptomatic histologically-diagnosed benign prostatic hyperplasia p. 1523
E Aigbe, E Irekpita, FE Ogbetere, UI Alili
DOI:10.4103/njcp.njcp_67_22  PMID:36149214
Background: Prostate-specific antigen (PSA) is elevated in the serum of most men with prostatic diseases. Benign prostatic hyperplasia (BPH) is the commonest of these diseases. The degree of enlargement of the prostate may determine the amount of PSA elaborated. Several reports in some parts of the world have shown a significant correlation between prostate volume (PV) and PSA. However, only a few reports have been documented in Nigeria, especially in the South-South region. Aim: This research aimed to ascertain if there is any correlation between prostate volume (PV), total PSA (tPSA), and free PSA (fPSA) in men with histologically diagnosed BPH. This knowledge may help in the estimation of PV from a given PSA. Patients and Methods: This prospective hospital-based study was carried out in a southern Nigerian tertiary hospital between November 2017 and October 2018. Eighty (80) eligible and consenting patients participated in the study and were enrolled at first contact in the urology clinic. Each patient's blood was taken for PSA estimation. The prostate volume was estimated by transrectal ultrasound scan (TRUS). Those who had tPSA values greater than 4 ng/mL whose biopsy report showed prostate malignancy were excluded from the study. A proforma was used to collect patients' sociodemographic and clinical information. Data were entered and analyzed with Statistical Package for Social Sciences version 22 (SPSS Inc., Chicago, IL, United States). For all statistical tests, P < 0.05 was regarded as significant. Results: The mean age of the patients for this study was 68.03 years. The mean prostate volume was 87.9 mL with a range of 34 to 234 mL. The mean tPSA was 5.5 ng/mL with ranges of 1.1 to 21.1 ng/mL. There was a significant correlation between PV and tPSA with a P value of 0.0001. This correlation was also shown between PV and fPSA with a P value of 0.0001. Conclusion: There is a statistically significant correlation between PV and PSA (both free and total) in men with symptomatic histologically diagnosed BPH. This finding showed that larger benign prostate glands elaborated greater amounts of PSA. It may, therefore, be appropriate to say that it is not in all cases of elevated serum tPSA that the possibilities of malignancy or inflammation should be entertained.
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Recurrent tumours of ameloblastoma: Clinicopathologic features and diagnostic outcome p. 1529
MC Nwoga
DOI:10.4103/njcp.njcp_82_22  PMID:36149215
Background: Ameloblastoma is a benign epithelial odontogenic tumor with a tendency for recurrence. The recurrent tumors behave unpredictably with atypical microscopic changes and likelihood of malignant transformation. Aims: To study the clinicopathologic features and diagnostic outcome of recurrent tumors of ameloblastoma in Enugu. This is a six-year (2012-2017) retrospective study of 17 consecutive patients with recurrent tumors of ameloblastoma in a Teaching Hospital in Nigeria. Materials and Methods: The relevant clinicopathologic information, histology slides, and blocks were retrieved and reviewed. Descriptive analysis was used to determine the frequency, tables for categorical variables, and a Chi-square test was used to determine the statistical significance. Result: Recurrent tumors constituted 33.3% (17/51) of all confirmed diagnoses of ameloblastoma. The diagnostic outcome of the recurrent tumors was conventional ameloblastoma 58.8% (10), unicystic ameloblastoma 5.9% (1), and ameloblastic carcinoma 35.3% (6). There was bilateral mandibular extension in 60.0% (9), pain 58.8% (10), ulceration 29.4% (5), and matted lymph nodes 5.9% (1). Tumors with positive fluid aspirates 82.4% (14) yielded dark-brown fluids in 90.0% (9) of recurrent ameloblastomas and in 66.7% (2) of ameloblastic carcinomas. Atypical peripheral hyperplasia, nuclear hyperchromatism, and increased vascularization were commonly observed in benign recurrences. The frequency of recurrence is significantly associated with the biological behavior of ameloblastoma P = 0.03. Conclusion: Recurrent tumors of ameloblastoma presented atypical features and malignant transformation.
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The efficacy of bismuth quadruple therapy, sequential therapy, and hybrid therapy as a first-line regimen for Helicobacter pylori infection compared with standard triple therapy p. 1535
M Koroglu, MA Ayvaz, MA Ozturk
DOI:10.4103/njcp.njcp_89_22  PMID:36149216
Background and Aim: To compare the effectiveness of first-line Helicobacter pylori eradication treatments as standard triple therapy (sTT), bismuth-containing quadruple therapy (BQT), sequential therapy (ST), and hybrid therapy (HT). Patients and Methods: 303 patients treated between July 2018 and June 2021 were studied. In this study, 76 patients in the sTT group, 78 patients in the BQT group, 75 patients in the ST group, and 74 patients in the HT group were randomly allocated. The diagnosis of H. pylori was made endoscopically. H. pylori stool antigen test was performed 4 weeks after finishing the treatment. Results: The mean age was 48.53 (13.48) in sTT, 49.04 (13.02) in BQT, 48.47 (14.54) in ST, and 47.45 (13.4) in HT. There was no significant age difference among the groups (P = 0.909). H. pylori eradication rate in intention-to-treat (ITT) analysis was 68.4% in sTT, 79.5% in BQT, 78.7% in ST, and 83.8% in HT. There was no significant difference between sTT, BQT, and ST regarding of eradication rate. The difference between HT and sTT was significant (P = 0.028). In the per-protocol (PP) analysis, the eradication rate was 74.3% in sTT, 88.6% in BQT, 86.8% in ST, and 92.5% in HT. There was a significant difference between sTT and BQT (P = 0.030) and sTT and HT (P = 0.004), whereas there was borderline significant difference between sTT and ST (P = 0.065). Conclusion: In terms of eradication, HT had the best rate, whereas the lowest rate was in the sTT treatment group. This study does not recommend using sTT because of the low eradication rates. This study recommends HT for overcoming antibiotic resistance and better results.
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A comparison of goldmann applanation tonometry and rebound tonometry measurements among patients attending a glaucoma clinic in Southwest Nigeria p. 1542
O Ashano, O Oderinlo, A Ogunro, E Ashano
DOI:10.4103/njcp.njcp_95_22  PMID:36149217
Background: The accurate measurement of intraocular pressure (IOP) is a fundamental basic examination in daily ophthalmic practice and is important in managing many ophthalmic diseases and conditions such as glaucoma, uveitis, and following trauma. Accurate measurement of IOP is particularly important in glaucoma because the intraocular pressure is the most important modifiable risk factor in its management. Aim: To compare intraocular pressure (IOP) measurements obtained with the Goldmann applanation (GAT) tonometer to intraocular pressure measurements obtained with the iCare rebound tonometer (RBT) and evaluate the suitability of the iCare tonometer for routine clinical use among adult patients attending a glaucoma clinic in Southwest, Nigeria. Patients and Methods: The study was a comparative cross-sectional study. A total of 132 eyes of 132 patients were recruited for the study. Three consecutive IOP measurements were obtained with each of the instruments by the same observer. A difference in IOP of ± 3 mmHg between the two instruments was considered clinically significant in this study. Results: The mean IOP measurement from GAT was 15.18 mmHg (±4.26 mmHg) and 16.32 mmHg (±4.48 mmHg) from RBT. The mean central cornea thickness was 520.66 μm (±33.34). Pearson's correlation (r = 0.84) revealed a strong statistically significant correlation between GAT and RBT measurements and paired student t-test revealed a statistically significant difference in the means of IOP obtained by the GAT and RBT. There was a tendency for RBT to yield higher IOP measurements. Conclusion: The intraocular pressure measurements obtained with iCare RBT and GAT though strongly correlated, showed statistically significant differences in the means. The impact of central cornea thickness on measurements obtained by GAT and RBT was statistically insignificant. The iCare rebound tonometer, cannot replace GAT for routine use in the glaucoma clinic.
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Investigation of the effects of marsupialization on histomorphological and immunohistochemical markers of odontogenic keratocysts p. 1548
E Baris, Atak Secen, S Karabulut, SE Gultekin
DOI:10.4103/njcp.njcp_103_22  PMID:36149218
Background: Despite its extensive bone resorption and high recurrence rate, marsupialization is the preferred option in the treatment of odontogenic keratocysts (OKCs). Aim: We aimed to assess the effect of marsupialization on histomorphological and biochemical markers of OKCs. Materials and Methods: The study is conducted on 48 paraffin blocks of 24 OKC cases between the years 2012 to 2018. The main clinical, radiographic, and histomorphometric measurements were recorded. Immunohistochemical staining with E-cadherin, Ki67, IL1α, TNFα, Slug, and Snail were performed and compared for pre-marsupialization and post-marsupialization values. Results: OKCs mostly located in the mandibular posterior region. The mean marsupialization period was 8.8 ± 6.5 (3-25) months. The mean radiographic size of OKC (57.1 ± 53.5 mm) was significantly reduced after marsupialization (22.6 ± 19.9 mm, P = 0.002). Histologically, significantly increased thickness of the OKC epithelium (p = 0.002) and collagen production (p = 0.034) was detected after marsupialization. The post-marsupialization group showed positive correlation of inflammation score to both TNFα (r: 0.69, P < 0.001) and IL-1α (r: 0.58, P = 0.008) expressions in connective tissue. Among immunohistochemical parameters, only Slug expression was significantly higher after marsupialization (p = 0.019). Conclusion: Our study suggests that increased Slug expression may enable the second surgery by increasing fibrosis in the cyst wall.
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Analysis of one-year postoperative mortality and risk factors of elderly patients with intertrochanteric fractures after PFNA p. 1557
J Gu, S He, L Wang
DOI:10.4103/njcp.njcp_109_22  PMID:36149219
Background: Intertrochanteric fracture is very common in elderly patients, It is one of the main reasons for the elderly to be hospitalized, and is closely related to the mortality rate. With the speeding up of the population aging, the treatment of intertrochanteric fracture is becoming more and more significant. PFNA (Proximal femoral nail antirotation) is the most commonly used surgical method, although the surgical technique has improved a lot, the postoperative mortality rate after one year is still high. If we can take active and effective control measures against the high-risk factors affecting mortality in time, it will help to improve the prognosis. Aim: To study the 1-year postoperative mortality rate of elderly patients with intertrochanteric fractures after being treated with proximal femoral nail antirotation (PFNA) and its influencing factors. Patients and Methods: The data of patients with intertrochanteric fracture treated by PFNA in our hospital during the period from August 2016 to April 2020 were retrospectively studied, and the data of age, sex, type of fracture, preoperative comorbid diseases, American Society of Anesthesiology (ASA) score, the timing of the operation, duration of operation, preoperative and postoperative hemoglobin levels, albumin level, and postoperative complications were collected through medical records, and the survival rate of patients in 1 year after operation was investigated by telephone follow-up, and single-factor analysis was carried out to analyze related influencing factors. Results: A total of 80 patients with complete data were followed up for 1–23 months (mean 12.5 months), and totally 22 patients died within 1 year, the mortality rate was 27.5%. Single analysis results suggested that the differences in factors such as age, number of preoperative combined diseases, ASA score, preoperative and postoperative albumin levels, and postoperative complications between the survival group and the death group were statistically significant (P < 0.05). Conclusion: The risk factors affecting long-term death in the treatment of intertrochanteric fractures in elderly patients with PFNA shall be taken into consideration fully, and the improvement of preoperative and postoperative health status will help to reduce the postoperative mortality and improve the efficacy of surgery.
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Remineralization activities of toothpastes with and without aloe vera with different ratios of fluoride on demineralized enamel: An In-vitro study p. 1563
C Yikici, S Ozcan
DOI:10.4103/njcp.njcp_132_22  PMID:36149220
AIM and Background: The aim of this in-vitro study was to evaluate and compare the efficacy of both pure aloe vera and commercially available toothpastes with different fluoride compounds and different fluoride amounts on artificial initial enamel lesions by Vicker's microhardness values. In the study, 72 extracted human molar teeth were divided into mesiodistal and 144 specimens were prepared using the vestibule and palatal/lingual surfaces of the teeth. After the surface treatments and initial microhardness measurements, all the specimens were placed in a demineralizing solution (pH: 4.5) for 7 days, resulting in artificial initial enamel lesion, and were randomly assigned to eight groups (n = 18). After the teeth were subjected to pH cycle for 14 days, microhardness measurements were repeated and the data were recorded. Materials and Methods: Statistical analyzes were performed using MedCalc Statistical Software version 12.7.7. The significance level was determined to be 0.05. Results: In the statistical results, when the microhardness values after demineralization and post-cycle were compared, Groups B1 and A2 showed the lowest values, while Groups A3 and B3 did not show a significant difference in terms of microhardness values after demineralization and post-cycle, and only Group B4 showed statistically significantly higher values. Conclusions: This study emphasized the remineralization effects of fluoride on initial enamel lesions. It can be said that toothpaste containing 1450 ppm fluoride and aloe vera provides an effective remineralization and sodium monofluorophosphate formulation may have a synergistic effect with aloe vera.
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The relationship between university students' depression, anxiety, and stress with positivity attitudes and the COVID-19 pandemic Highly accessed article p. 1571
NU Ocal, M Kilic, G Uslukilic
DOI:10.4103/njcp.njcp_135_22  PMID:36149221
Background: The physical activity of university students is restricted during the pandemic, changes in education and training, and uncertainties during the pandemic caused their social lives to change completely. Aim: This study aims to determine the relationship between the depression, anxiety, and stress, and positivity attitudes of university students during the Covid-19 (coronavirus disease-2019) outbreak and their attitudes and behaviors toward the pandemic. Subjects and Methods: This cross-sectional study was conducted online among university students, n = 2153 from April 30, 2020 to May 10, 2020. Data were collected with the Positivity Scale and the Depression Anxiety Stress Scale. Results: The proportion of those with moderate and above depression, anxiety, and stress symptoms in the study group, respectively, were 40.6%, 24.6%, and 22.5%. The risk ratio of these symptoms is higher among those with lower positive attitudes (OR [odds ratio] = 0.804, 0.897, 0.895, respectively), being women (OR = 1.446, 1.666, 1.471), who are concerned with the transmission of the Covid-19 (OR = 1.144, 1.374, 1.201), who believe their intra-family relations (OR = 1.886, 1.728, 2.083) and education (OR = 1.680, 1.682, 2.132) are negatively affected, and those who are more worried about life after the pandemic. Conclusion: Compared with the pre-pandemic period, the frequency of university students showing symptoms of depression increased, and there was no significant change in anxiety and stress levels.
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Colonoscopy in Zaria: Indications and findings p. 1580
M Manko, AK Bello, MF Mohammed, AM Jabir, IA Isah, M Daniyan, SM Mado, SK Mustapha, MM Dauda
DOI:10.4103/njcp.njcp_150_22  PMID:36149222
Background: Colonoscopy is an important procedure in the management of colorectal diseases. During a colonoscopy, one can visualize the mucosa of the large bowel and perform therapeutic procedures. Aim: The aim of this study is to review the indications and findings of colonoscopy in our center. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register. Patients and Methods: The study is a retrospective descriptive one and included all patients who underwent colonoscopy between June 2017 to December 2019 at the endoscopy unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) statistical software version 20. Results: One hundred and twenty-five patients had a colonoscopy during the period under review with a male to female ratio of 1.9:1. The age range of the patients was 3 to 85 years and the mean age was 46.7 ± 16.7 The most common indications for colonoscopy in our center were lower gastrointestinal bleeding (40 (32%)), followed by suspected colonic tumors (37 (29.6%)), and hemorrhoids (18 (14.4%)). The commonest findings were hemorrhoids (50 (40%)), colonic tumors (25 (20%)), and colitis (21 (16.8%)). Conclusion: A colonoscopy is an effective tool in the management of colorectal diseases. Lower gastrointestinal bleeding was the commonest indication for colonoscopy in our center and hemorrhoids and colorectal tumors were the commonest findings.
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Clinicopathological profile of myxoid soft tissue tumors- A retrospective study in a tertiary care hospital in South India p. 1584
Karthik Sigamani, Karkuzhali Ponnuswamy
DOI:10.4103/njcp.njcp_292_22  PMID:36149223
Background: Myxoid soft tissue tumors are rare and diagnostically challenging group of tumors with varied biological behavior ranging from benign, locally aggressive to distantly metastasizing malignant tumors. Aims: The objectives of the study are to identify the relative frequency and distribution of myxoid soft tissue tumors among patients in a tertiary care hospital and to study the clinicopathological features of these tumors. This was a retrospective cross-sectional study conducted in the department of pathology of a tertiary care hospital from January 2008 to December 2013. Materials and Methods: Clinical and pathological details of all the 80 myxoid soft tissue tumors reported during the study period were retrieved from the records of department of pathology. Corresponding Hematoxylin & Eosin (H & E) slides were reviewed, and Immunohistochemistry (IHC) was carried out for confirmation. The relationship among various prognostic variables was analyzed in case of myxoid sarcomas. Results: Myxoid soft tissue tumors accounted for 3.7% among the soft tissue tumors with a predominance of malignant myxoid sarcomas (71.25%) in contrast to the overall picture of sarcomas. Myxoid neurofibroma (34.78%) was the most common benign tumor, while myxofibrosarcoma (33.33%) was the frequent myxoid sarcoma. A statistically significant correlation was seen between tumor size and depth (P-value: 0.038) and also between presence of vascular invasion and histological grade (P-value: 0.012) of sarcomas. Conclusion: Light microscopic morphology, supplemented by ancillary techniques like IHC, remains the cornerstone for diagnosis of myxoid soft tissue tumors.
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Effects of lead exposure on biomarkers of thyroid and renal function tests among panel beaters in Enugu Metropolis, Nigeria p. 1593
CW Kassy, IA Meka, CJ Okwor, OD Onodugo, NP Onodugo, EN Aguwa
DOI:10.4103/njcp.njcp_1845_21  PMID:36149224
Background: Occupational lead (Pb) exposure causes multisystem effects at high and sustained low doses. However, there are inconsistencies in the dose–response effects on the thyroid and kidneys. Aim: This study aimed to assess the effects of Pb exposure on the biomarkers of thyroid and renal functions among panel beaters in Enugu Metropolis, Nigeria. Subjects and Methods: This was a cross-sectional analytical study of 428-panel beaters selected using a multistage sampling technique. Blood lead (BPb), thyroid, and kidney biomarkers were analyzed using atomic absorption spectrometer at 238.3 nm wavelength, enzyme-linked immunosorbent assay, and automated chemistry analyzer, respectively. Analyses were performed using median, mean, Chi-square, correlation, and statistical significance. Results: The median BPb levels were 10.0 μg/dl among participants with about half, 211 (49.3%) having BPb within reference levels. Though the mean values of thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), and creatinine (Cr) were within the reference values, the majority of 275 (64.25%) of the participants had non-euthyroid statuses. Significant differences were found in TSH (P = 0.001), thyroid status (P = 0.0129), and estimated glomerular filtration rate (P = 0.00384) between those with BPb within reference level and those with elevated levels. Conclusion: Though the mean levels of thyroid hormones and Cr were within their respective reference intervals, there was a preponderance of non-euthyroid status among participants in the present study with the majority of the participants falling within CKD grades 2 and 3.
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Non operative treatment of obturator dislocation with indentation fracture of the femoral head: A case report p. 1601
CO Anisi, IE Abang, OG Osakwe, JE Asuquo
DOI:10.4103/njcp.njcp_262_22  PMID:36149225
Traumatic anterior hip dislocation is quite rare and accounts for 7% to 15% of all hip dislocations. Approximately 70% of anterior hip dislocations are the obturator type and represent less than 7% of all hip dislocations. Indentation fracture of the femoral head complicates 35–55% of obturator dislocations. Features of osteonecrosis of the femoral head and osteoarthritis of the hip joint may manifest within 2 years. Our index patient is a 19-year-old female who had conservative treatment for right obturator dislocation with indentation fracture of the femoral head. She recovered fully and had no features of osteonecrosis or secondary arthritis at 2 years postinjury. The aim of this report is to highlight the role of conservative treatment in the management of obturator dislocation with indentation fracture of femoral head.
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Dyke-davidoff-masson syndrome: A case report of an adolescent boy at a tertiary hospital in Adamawa, North-Eastern Nigeria p. 1604
AB Usman, P Emmanuel, NP Namuya, DB Manchan, AM C Dahiru, N Raheem, AU Usman, K Hirayama
DOI:10.4103/njcp.njcp_1955_21  PMID:36149226
Dyke-Davidoff-Masson Syndrome (DDMS) is a rare clinical condition in which atrophy or hypoplasia of one cerebral hemisphere occurs secondary to brain insult during fetal or early childhood, which results in variable clinical manifestations like hemiparesis, seizures, expressive aphasia, and mental retardation. This rare entity mainly presents in childhood and is unusual in adults. DDMS is a rare cause of epilepsy and should be considered and excluded in cases of refractory seizures. Few cases have been reported from a developing nation like Nigeria but not from the north-eastern part of Nigeria to the best of our knowledge. Though fewer specialists exist in Adamawa State, efforts to train more specialists and education of medical officers to manage this rare case need to be strengthened. Herein is a case of an adolescent boy with recurrent generalized tonic-clonic convulsions complicated by left-sided hemiparesis, expressive aphasia, and mental age equivalent of a six-year-old by the Goodenough draw-a-person test. Found to be obese with Body Mass Index (BMI) of 29 kg/m2 (Z-score >2 Standard deviation SD), microcephaly, Occipito-frontal Circumference (OFC) of 45 cm (Z-score > –3 SD), spastic left-sided hemiplegia and hemiplegic gait. Magnetic resonance imaging (MRI) of the brain showed hyper-intensity in the right cerebral hemisphere, extensive atrophy of the right cerebral hemisphere involving the ipsilateral fronto-temporoparietal lobes, cerebral peduncle, and a contralateral megalencephaly, ipsilateral lateral ventricular dilatation, hypertrophic calvarium, hyperpneumatization of sphenoidal sinuses and midline shift due to loss of volume on the right. A diagnosis of Dyke-Davidoff-Masson syndrome was made; the patient did well on carbamazepine and physiotherapy. Caregivers were counseled, and the patient was discharged home and is currently on a follow-up visit.
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Primary extraskeletal Ewing's sarcoma presenting as an axillary mass: A case report and review of the literature p. 1608
AM Albasri, IA Ansari, AR Aljohani, AS Alhujaily
DOI:10.4103/njcp.njcp_196_22  PMID:36149227
Extraskeletal Ewing's sarcoma (EES) is a rare soft tissue tumor predominantly observed in adolescents and young adults, and is characterized by aggressive behavior. So far, only two cases of primary axillary soft tissue EES have been reported in the literature. One of them was a 29-year-old female patient who presented with a lump in her left axilla. Upon examination, an irregular, painless mass, measuring 5 cm × 5 cm × 3 cm, was noted in the left axilla. A histopathological examination of the mass revealed small, round, blue cells with scant cytoplasm, round nuclei, numerous mitosis, and necrosis. An immunohistochemistry (IHC) examination was positive for CD99 and negative for ER, PR, Her2neu, CK7, CK5/6, CD56, CD45, CK-pan, CKHMW, P63, desmin, S100, TdT, vimentin, myogenin, synaptophysin, and chromogranin A. The patient was diagnosed with primary axillary soft tissue EES and was started on neoadjuvant chemotherapy. Twelve months later, she is clinically free from the disease.
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Etiologic dilemma and challenges of management of nodular vasculitis in tertiary health-care facility: A case report p. 1611
JN Eze, CL Odimegwu, OC Okafor, IN Nwafia
DOI:10.4103/njcp.njcp_348_22  PMID:36149228
Nodular vasculitis is a rare inflammatory disease of the skin and subcutaneous fat tissue, characterized by crops of small, tender, erythematous nodules on the legs, mostly on the calves and shins. We present a 17-year-old adolescent female who presented with a six-month history of cough; recurrent fever and bilateral lower limb multiple ulcerated nodules of 1-month duration. Clinical examination revealed generalized lymphadenopathy with bilateral pitting leg edema which had multiple nodules and discoid ulcers extending from the groin to the ankles and discharging purulent fluid. Tests for human immunodeficiency virus and tuberculosis were negative. Histology of nodule biopsy revealed extensive caseous and coagulative fat necrosis, granulomatous inflammation with epitheloid macrophages and multinucleated giant cells surrounding the necrosis, and lymphoid infiltration of vessel walls with fibrous thickening of the intima, typical of Whitfield-type erythema induratum. There was initial but very transient response to antibiotic treatment, with further deterioration and eventual death from overwhelming sepsis.
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