Medical and Dental Consultantsí Association of Nigeria
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   Table of Contents - Current issue
November 2021
Volume 24 | Issue 11
Page Nos. 1573-1758

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Prevalence and risk factors associated with musculoskeletal disorders among pregnant women in Enugu Nigeria p. 1573
NO Onyemaechi, CO Chigbu, EO Ugwu, NI Omoke, OA Lasebikan, BC Ozumba
DOI:10.4103/njcp.njcp_522_20  PMID:34782493
Background: Pregnancy usually triggers a wide range of changes that result in a variety of musculoskeletal disorders (MSDs). The scope and burden of these disorders in Nigeria are not known. Aim: The study aimed to determine the prevalence and risk factors of pregnancy-related MSDs in Enugu. Patients and Methods: A cross-sectional study of pregnant women attending antenatal clinics at three tertiary hospitals in Enugu, Nigeria, was done using an observer-administered questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. Results: A total of 317 participants were studied. A majority of the participants (93.1%) had one or more MSDs. Low back pain (LBP) and muscle cramps were the two most common pregnancy-related MSDs with prevalence rates of 56.8 and 54.8%, respectively. Increasing gestational age (P = 0.001), previous pregnancies (P = 0.027), and occupation (P = 0.018) were associated with increased risk of MSDs. A majority of the MSDs were of mild and moderate severity and 10.4% of the participants had significant impairment of their daily activities. Conclusion: MSDs are common in pregnancy with LBP and muscle cramps as the most prevalent conditions. Increasing gestational age, multigravidity, and occupation increased the risk of MSDs among our cohorts. Preventive and therapeutic measures should be instituted when necessary to ensure optimal maternal health during pregnancy.
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Variations in utilization of health facilities for information and services on sexual and reproductive health among adolescents in South-East, Nigeria p. 1582
IC Agu, CO Mbachu, U Ezenwaka, C Okeke, I Eze, I Arize, N Ezumah, O Onwujekwe
DOI:10.4103/njcp.njcp_48_21  PMID:34782494
Background: Adolescents' sexual and reproductive health has an important influence on a country's long-term national growth. There is a high level of burden due to poor adolescent sexual and reproductive health (ASRH) in Nigeria, especially the Ebonyi State. Evidence shows that in the Sub-Saharan African region, most adolescents experience poor access to information and other services relating to their sexual and reproductive health. Many cultures in Africa see matters around sex and sexuality as social taboos. Aims: This study aimed to access variations in the utilization of health facilities for sexual and reproductive health information and services among adolescents in the Ebonyi State, Nigeria. This will inform the design of interventions to improve ASRH. Patients and Methods: A total of 1,057 in-school and out-of-school adolescents aged 13–18 years were selected using cluster sampling of households from the six selected local government areas (LGAs) in this cross-sectional survey. Structured questionnaires were used to collect data. Descriptive statistics were performed alongside stratification analysis. Tabulation, bivariate and multivariate logistic regression analyses were undertaken. A household wealth index was calculated using the total household consumption calculated divided by the number of people in the household (per capita household consumption). The per capita household consumption was used to categorize the households into socioeconomic quintiles. The variable was used to differentiate key variables into socioeconomic quintile equity analysis. Results: A majority of the respondents had never visited any type of health facility to receive either sexual and reproductive health (SRH) information (90.2%) or services (97.1%). The utilization rate of health facilities for SRH information was 9.8% while for other SRH services was 2.8%. The patent medicine vendor (PMV) was the most visited type of facility for SRH information and other services. Schooling was a strong predictor of health facilities' utilization for SRH information (P < 0.01) and other services (P < 0.01). Conclusion: Utilization of health facilities for information and services among adolescents in the Ebonyi State is very low and favorable toward informal service providers such as PMVs. The establishment and strengthening of the existing youth-friendly centers, school clinics, and occasional outreach programs designed specifically to target adolescents would perhaps improve adolescents' access to adequate information and health facility utilization for sexual, reproductive, and health services.
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Predictors of early elbow function following paediatric humeral supracondylar fractures: A retrospective analysis p. 1590
HC Ekwedigwe, UE Anyaehie, O Ede, IA Anikwe, GO Eyichukwu, JK Anieze
DOI:10.4103/njcp.njcp_18_21  PMID:34782495
Background: Supracondylar fracture usually occurs as a result of fall on an outstretched hand. Prompt management is essential to prevent complications. Functional outcome after management of this fracture may be predicted by some factors. Aims: The study aimed to review the management of supracondylar fractures and determine what factors have an impact on the functional outcome of the elbow using MEPS score in the early post-operative period. Patients and Methods: This study was a retrospective study of all patients with supracondylar fractures that presented at the accident and emergency department of a tertiary institution over a 2-year period. Their relevant data were retrieved from their folders and analysis done using SPSS 20. The MEPS score at 6 months was calculated. Multiple linear regressions were used to determine factors that can predict early elbow function using the MEPS score at 6 months. Results: In the study, 61.4% (35) patients were males and 38.6% (22) females. The commonest mechanism of injury was fall on the outstretched hand (FOOSH), 70.2%. The mean duration of presentation to the hospital was 38 h (SD = 56.9). Among treatment offered to the patients, a higher number had open reduction with pinning. The mean postoperative Mayo elbow score was 87.6. Age of patients, Gartland type and the duration of cast immobilization were significant predictors of the MEPS at 6 months after treatment. Conclusion: The Gartland type and duration of cast immobilization are the most important predictors of the MEPS score at 6 months in this study.
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Morphological evaluation of the incisive canal with reference to gender and age: A cone-beam computed tomography study p. 1596
AI Linjawi, MA Othman, AA Dirham, SH Ghoneim, SR Aljohani, RR Dause, HY A Marghalani
DOI:10.4103/njcp.njcp_40_21  PMID:34782496
Background: The incisive canal (IC) is an important anatomical structure in the premaxilla that should be considered during many dental procedures. Aims: The objective of this study is to associate the IC morphology and dimensions with reference to gender and age by means of cone-beam computed tomography (CBCT). Patients and Methods: A retrospective study was conducted using archived CBCT records of patients who sought treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. OnDemand 3D Imaging software was utilized in image reconstruction and measurement determination. The parameters evaluated were the IC shape and dimensions in a sagittal and coronal view at two levels: palatal opening and nasal opening. The variables were compared according to age and gender using one-way Analysis of Variance (ANOVA) and Kruskal Wallis tests. Confidence level was obtained at P < 0.05. Results: Out of the 370 CBCT images assessed, only 100 images fulfilled the inclusion criteria; 50 males and 50 females. No substantial variance in IC shapes was found in both the sagittal and coronal perspectives with reference to age and gender. Likewise, there was no statistical variation in IC dimensions with reference to age. On the other hand, there was a statistical difference in IC length when correlated with gender as the male subjects had longer IC as compared to females (P < 0.01). Conclusion: There is no association between IC morphology, age and gender. However, substantial variation in IC length was observed between genders.
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Prognostic significance of the metastatic lymph node ratio compared to the TNM classification in stage III gastric cancer p. 1602
S Gulmez, AS Senger, O Uzun, S Omeroglu, C Ofluoglu, ZO Sert, A Oz, E Polat, M Duman
DOI:10.4103/njcp.njcp_345_20  PMID:34782497
Background: We aimed to evaluate a comparative analysis of the prognostic value of the metastatic lymph node ratio (LNR) and pN (TNM) in stage III gastric cancer. Patients and Methods: A total of 159 stage III gastric cancer patients with curative gastrectomy were retrospectively analyzed. Cutoff values for LNR were designated according to 25%, 50% and 75% percentiles, 0.07, 0.20 and 0.44 respectively. The LNR was divided into four groups as 0 > LNR1 ≤ 0.07; 0.07 > LNR2 ≤0.20; 0.20 > LNR3 ≤0.44; 0.44 > LNR4 ≤1. Results: The mean age of the patients was 61.1 ± 11.3 years. Male predominance was apparent (73.6%). The 1-year overall survival and recurrence rates were 73.6% and 33.6%, respectively. The univariate cox regression analysis demonstrated age and LNR were the main variables that affected overall survival (OS) (p < 0.05). Harvested lymph nodes less than 16 did not affect OS (p = 0.255). The results of the multivariate cox regression analysis revealed that only LNR was an independent prognostic factor (P < 0.001), while pN was not (p > 0.05). Similar results, as with overall survival, could not be revealed clearly for disease free survival (DFS). Conclusions: LNR was an independent significant prognostic factor and superior to pN staging in predicting OS but not for DFS in stage III gastric cancer patients. The high LNR levels in our research were found to be associated with poor survival rates. The percentile system we used to determine cutoff values may be considered as a reliable method. Similarly, LNR also provides a reliable prognostic parameter in future staging systems to help guide treatment algorithm plans.
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Comparison of anthropometric and conic beam computed tomography measurements of patients with and without difficult intubation risk according to modified mallampati score: New markers for difficult intubation p. 1609
D Senol, D Ozbag, N Dedeoglu, F Cevirgen, S Toy, M Ogeturk, E Kose
DOI:10.4103/njcp.njcp_694_20  PMID:34782498
Background: The aim of this study was to compare the anthropometric and cone beam computed tomography (CBCT) measurements taken from risk-free and risky groups by using the modified Mallampati score (MMS). Patients and Methods: A total of 176 volunteers between the ages of 18 and 65 in four different MMS classes were included in the study. The patients in classes MMS I and MMS II were accepted as risk-free and the patients in classes MMS III and MMS IV were accepted as risky for intubation. The Mann–Whitney U test was performed on the data to compare the anthropometric and radiological measurements taken from the risk-free and risky groups. A receiver operating characteristic (ROC) analysis was applied to the parameters that had a statistically significant difference. Results: According to the analysis results, statistically significant differences were found in the neck circumference (NC), maximum interincisal distance (MID), thyromental distance (TMD) and sternomental distance (SMD) of the anthropometric measurements of men and women between the risk-free and risky groups (P < 0.05). In terms of CBCT measurements, the thickness of the tongue (TT), distance between the uvula and posterior wall of pharynx (U-Ph), distance between posterior nasal spine and nasopharynx (Snp-Nph) and length of the epiglottis (LE) were found to have statistically significant differences between the risk-free and risky groups of men and women (P < 0.05). Conclusion: The NC, MID, TMD and SMD anthropometric measurements and TT, U-Ph, Snp-Nph and LE radiologic measurements were found to support MMS, which is one of the most widely used bedside intubation prediction tests. In addition to the inclusion of CBCT for intubation prediction, U-Ph and Snp-Nph radiologic measurements were added as difficult intubation markers.
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Association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents p. 1616
S Firat, NH Nogay
DOI:10.4103/njcp.njcp_685_20  PMID:34782499
Background: Determining high blood pressure in childhood is an important step to reduce the risk of occurrence of high blood pressure–related diseases in adulthood. Aims: This study aimed to assess the association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents. Patients and Methods: This cross-sectional study included 370 students (202 females, 168 males) aged 14 to 18 years from one private and one public school in Kayseri, Turkey. Some anthropometric measurements and 24-hour dietary recall of the students were obtained. Their blood pressures were measured, and the International Physical Activity Questionnaire and the Mediterranean Diet Quality Index (KIDMED) were used. Results: The body mass index (BMI) mean and waist/height ratio of the hypertensive group were significantly higher than those of the prehypertensive group, whereas their daily potassium, calcium, and magnesium intakes were significantly lower than those of the normotensive group. The percentage of individuals with very low diet quality was higher in the hypertensive group than in the normotensive group (P > 0.05). The percentage of participants with sufficient physical activity was higher in the normotensive group than in the prehypertensive and hypertensive groups. Conclusion: Factors such as high BMI and waist/height rates; low calcium, magnesium, and potassium intakes with diet; insufficient physical activity; and low quality of diet might cause an increase in the blood pressure.
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The effect of continuous supportive care on birth pain, birth fear, midwifery care perception, oxytocin use, and delivery time during the intrapartum period: An experimental study p. 1624
S Cankaya, R Can
DOI:10.4103/njcp.njcp_147_20  PMID:34782500
Background: Intrapartum professional midwifery support can improve the coping skills with the fear of childbirth and birth pain, increase the perception of the woman, and prevent negative experiences. However, there are relatively few studies supporting this postulation. Aims: To investigate the effects of supportive care given during labor on birth pain, birth fear, perception of midwifery care, oxytocin use, and delivery time. Patients and Methods: This is a quasi-experimental study. We collected the data between January and June 2019 in a province in Central Anatolia, Turkey. Primiparous 102 pregnant women were included in the study. However, we excluded five pregnant women from the intervention group and four pregnant women from the control group as emergency cesarean section developed. In total, 93 pregnant women, 46 in the continuous supportive care intervention group, and 47 in the usual intrapartum care control group were evaluated. The following tools were used to collect data: The Delivery Fear Scale, a Visual Analog Scale for perceived pain, the Scale of Women's Perception for Supportive Care Given During Labor, and labor outcomes information form. Results: The participants in the intervention group receiving continuous intrapartum supportive care had less fear of birth and lower birth pain in the active and transitional stages of labor, their midwifery care perception increased, and the duration of labor was shorter (P < 0.05). However, there was no significant difference in oxytocin use between the two groups at 95% confidence interval (-0.265-0.091) (p > 0.05, Cohen's d = 0.2). Conclusion: Pregnant women who received continuous intrapartum supportive care had less fear of birth and reduced labor pain in active and transitional stages of labor. In addition, with the continuous supportive care provided, the perception of midwifery care of the pregnant women increased and the duration of labor decreased. Therefore, midwifery care support should be provided to women throughout their labor and delivery process.
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Prevalence study for postoperative nausea vomiting: A training hospital example p. 1633
E Canakci, T Catak, HE Basar, Z Cebeci, I Coskun, AO Saltali, A Altinbas
DOI:10.4103/njcp.njcp_399_20  PMID:34782501
Background: Simplified risk models, such as the Apfel score, have been developed to calculate the risk of postoperative nausea-vomiting (PONV) for adult patients. In the absence of any risk factors, PONV risk is assumed to be 10%. While the presence of one of the four risk factors determined as female gender, non-smoking, PONV/car sickness history, and postoperative opioid use is associated with 20% risk for PONV, the risk increases by 20% with the addition of each risk factor, and reaches to 80% if four factors are present. Aim: Our aim in this study is to investigate the prevalence of PONV, and whether the scoring systems used for nausea-vomiting in the literature are still valid. Patients and Methods: Five groups of patients were included in the study with an Apfel score of 0, 1, 2, 3, 4. Each case was taken to the recovery room at the end of the operation. They were observed whether had nausea-vomiting was recorded according to the Abramowitz emesis score. Results: While the PONV risk for women is 24.637 times higher than men, the PONV risk of those who had gynecological surgery is 6.27 times higher than that of the other type of surgery. Those who had urological surgery are 0.345 times less than the other type of surgery. Those who had lower abdominal surgery had a risk of PONV of 4.56 times higher than the others. As the duration of the case increases, the risk of PONV increases 1.01 times (P values P < 0.001, P < 0.001, P < 0.001, P = 0.048, P < 0.001, respectively). Conclusion: As a result, our PONV prevalence is considerably lower than the frequency rates mentioned in the literature. PONV scoring systems need long-term studies with larger populations to be updated.
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Effect of type 1 tympanoplasty on the quality of life of patients suffering from chronic otitis media (safe type) p. 1641
KJ Devi, M Singh, AS Maan, O Thomas, G Kaur, S Arya, J Kaur
DOI:10.4103/njcp.njcp_23_21  PMID:34782502
Background: Chronic otitis media (COM) remains a major public health issue and is associated with relentless discharge from the ear, pain, significant functional limitation of hearing, leading to communication problems and frequent specialist visits. Aims: To assess the improvement in quality of life of patients of COM (safe type) and surgical success in terms of graft uptake and improvement in hearing. Patients and Methods: A prospective questionnaire-based outcome study was directed in 100 patients with COM who were treated with Type I Tympanoplasty at our institution between May 2018 and May 2020. All patients were asked to fill Modified Chronic Otitis Media 4 (COM-4) survey before operation and 3 months after operation. Preoperative and postoperative total ear scores, audiological results, postoperative graft uptake were assessed. Results: The correlation between preoperative and postoperative assessment by questionnaire was statistically critical (P < 0.001). There was significant improvement in hearing postoperatively (P < 0.001). Effective graft uptake was seen in 80%. Conclusion: The current study emphasizes that Type 1 Tympanoplasty fundamentally improves quality of life of patients in terms of physical suffering, hearing loss, emotional distress postoperatively.
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Child deaths due to firearm-related İnjuries in Adana, Turkey p. 1645
K Kaya, E Akgunduz, Z Erdem, A Hilal
DOI:10.4103/njcp.njcp_549_20  PMID:34782503
Background: Death by firearm is unacceptable for children who need to be under the protection of the state and the family, wherever and however. Firearm-related fatality is common among all ages. One of the causes of this high rate is likely the easy access to firearms. Aim: This study aims to discuss the characteristics of deaths attributable to childhood firearm injuries in Adana, Turkey and to compare them with similar studies. Patients and Methods: In this study, the records of 448 (1.97%) cases under 18 years of age who died due to firearm-related injuries among a total of 22,668 cases whose autopsies were performed by the Morgue Department, Council of Forensic Medicine Adana Group Administration between January 1, 2004 and December 12, 2017 were retrospectively evaluated. Results: Age ranged from 45 days to 18 years; 285 cases were male and 163 cases were female, and male/female ratio was 1.7. The majority of cases were between 13 and 18 years of age (n: 340, 76.0%). According to the manner of death, the leading cause was homicide (n: 212, 47.4%) and the most frequently used type of firearm were shotguns (n: 226). Single firearm wound was present in 82.8% of the cases. The location of entrance wounds revealed that 185 wounds were located in the head-neck. Although homicide was the leading manner of death among the overall cases, it was determined that suicide was the leading cause among the 13-18 age group (n: 149). Firearm-related injuries and deaths in children should bring child neglect to the agenda. Conclusion: Presence of firearms at home and easy access are the causes of increased firearm injuries and death in children. Easily accessible weapons in homes are often involved in suicides and homicides, as well as accidents, which are more common in young children and adolescents. We believe that the use of firearms outside of the security forces should be prohibited and that strict laws should be enforced on the handling and use of firearms.
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Comprehensive evaluation of factors that induce gingival enlargement during orthodontic treatment: A cross-sectional comparative study p. 1649
YA Almansob, MS Alhammadi, XJ Luo, MN Alhajj, L Zhou, HA Almansoub, J Mao
DOI:10.4103/njcp.njcp_69_21  PMID:34782504
Background: Gingival enlargement (GE) is one of the most common soft tissue problems encountered during fixed orthodontic treatment. Aims: This study aimed to evaluate the factors affecting GE in adolescents and young adults, compared with their normal peers. Subjects and Methods: This is a cross-sectional comparative study. The sample consisted of 329 subjects (ages 10–30 years) of both genders, which was divided into four main groups: The control group (G0) with no orthodontic treatment; subjects who underwent orthodontic treatment were divided according to treatment duration into G1 (4–12 months), G2 (13–24 months), and G3 (>24 months). The clinical examinations included the level of debris, calculus (simplified oral hygiene), and GE indices. Regression analyses were used to assess the GE association in all the studied groups. Results: The mean GE score increased significantly with increased treatment duration (0.42 ± 0.29 for G0 and 1.03 ± 0.52 for G3). GE scores of the lower arch were significantly higher in the anterior segment than in the posterior segment among all treatment groups. Regression analysis revealed that gender, age, oral hygiene, and treatment duration had a significant effect on GE (P < 0.05), while angle classification, overjet, overbite, treatment stage, bracket type, and therapeutic extraction did not show significant associations (P > 0.05). Conclusion: Gender, age, oral hygiene, and treatment duration were the most important risk factors for GE during fixed orthodontic treatment.
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Prevalence of apical periodontitis between root canal-treated and non-treated teeth and between genders: A cross-sectional CBCT study p. 1656
M Mashyakhy, M Alkahtany
DOI:10.4103/njcp.njcp_627_20  PMID:34782505
Background: Apical periodontitis (AP) is one of the most important prognostic factors in almost all endodontic outcome studies. The high prevalence of AP has been reported in different populations. Aims: The aim of the present study was to investigate (a) the overall prevalence of AP among all permanent teeth, (b) the differences between root canal-treated (RCT) and non-treated teeth in association with AP, and (c) the influence of gender on AP in a Saudi Arabian population using cone-beam computed tomography (CBCT). Materials and Methods: A total of 208 CBCT radiographs (including 5,504 permanent teeth) were investigated. The CBCT machine used in this study was a 3D Accuitomo 170 (Morita, Japan) with the following features: 90 kV, 5–8 mA, 17.5 s exposure time, and 0.25 mm voxel size. The radiographs of the axial, coronal, and sagittal segments of each tooth were acquired to evaluate the presence or absence of RCT teeth and AP. The data were presented as frequencies and percentages. Z test was used to analyze the differences in proportions at the significance level of P < 0.05. Results: The overall prevalence of AP was 4.5% (264 out of 5,504 permanent teeth). AP had the highest frequencies in the mandibular and maxillary first molars (18.4 and 9.3%, respectively) with a higher prevalence in the maxillary teeth. AP was associated with endodontically treated teeth more than the untreated ones (66.3% compared with 33.7%) with a highly significant difference (P < 0.001). AP was more prevalent in females than in males but with no statistically significant difference (P > 0.05). Conclusion: AP had a low prevalence (4.5%) in all permanent teeth and was highly associated with RCT teeth (66.3%). First molars had the highest prevalence of AP. Care must be taken when examining patient radiographs to avoid missing AP, particularly in RCT teeth.
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The effectiveness of ethylenediaminetetraacetic, etidronic, and peracetic acids activated with ultrasonics or diode laser on calcium hydroxide removal from root canal walls p. 1662
IG Savur, OI Ulusoy
DOI:10.4103/njcp.njcp_539_20  PMID:34782506
Background: To assess the efficiency of ethylenediaminetetraacetic acid (EDTA), etidronic (HEBP), and peracetic (PAA) acids agitated with ultrasonic energy or diode laser on removing calcium hydroxide (CH) dressings from root canal walls. Material and Methods: Single root canals of eighty extracted human teeth were chemomechanically instrumented and filled with CH. Sixty teeth were divided into six experimental groups (n = 10) according to the applied irrigation regimens for the removal of CH: Group 1: 5.25% NaOCl—17% EDTA, Passive ultrasonic irrigation (PUI); Group 2: 5.25% NaOCl + 9% HEBP, PUI; Group 3: 5.25% NaOCl—2% PAA, PUI; Group 4: 5.25% NaOCl—17% EDTA, Diode laser-activated irrigation (LAI); Group 5: 5.25% NaOCl + 9% HEBP, LAI; Group 6: 5.25% NaOCl—2% PAA, LAI. The other 20 teeth were served as negative (n = 10) and positive controls (n = 10). The residuary amount of CH was scored in coronal, middle, and apical thirds of the root canals by using scanning electron microscope. The data were statistically analyzed using Kruskal-Wallis H with Bonferroni adjusted Mann-Whitney U test with a significance level of 0.05. Results: Etidronic acid activated with ultrasonics or diode laser removed the highest amount of CH from the middle third of root canals, compared to the other irrigation regimens (P < 0.001). Although the residual CH scores of PAA-PUI, PAA-LAI, and EDTA-PUI, EDTA-LAI groups were not statistically different from each other (P > 0.05), lower amount of CH was observed in the PAA-PUI and PAA-LAI groups. Conclusions: Use of etidronic acid activated with ultrasonics or diode laser can be an appropriate irrigation regimen for CH removal from root canal system.
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Analysis of patients undergoing surgical treatment for primary spontaneous pneumothorax p. 1669
M Cakmak, A Durkan
DOI:10.4103/njcp.njcp_361_20  PMID:34782507
Background: Primary spontaneous pneumothorax (psp) results from spontaneous rupture of bleb or bulla. Aims: We planned to discuss the etiologic factors, clinical and radiological findings, and treatment results of psp cases. Materials and Methods: 402 patients were evaluated. Patients were divided into two groups as patients receiving positive results with thoracostomy and patients who received positive results thoracotomy/video-assisted thoracoscopic surgery (vats). Groups were compared. Results were evaluated using Chi-square or Fishers' exact test. P < 0.05 was considered as significant. Results: Gender difference (P: 1.00) and localization of disease (P: 0.45) were not significant for psp. Smoking and being subtotal or total compared to partial had a substantial effect on the implementation of thoracotomy/vats (P < 0.05). Furthermore, psp was most frequently seen in August and September. Discussion: Risk factors of psp are described as genetic predisposition, being tall, smoking, and autosomal dominant heredity. The main determinant factor in the treatment of psp is the degree of pneumothorax. Conclusion: Psp was frequently observed in smokers. The preferred method for overall psp is tube thoracostomy. Thoracotomy/vats is more commonly performed for subtotal or total psp compared to partial psp.
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Etiology, pattern, and treatment of nose fractures: A 10-year cross-sectional cohort retrospective study p. 1674
M Juncar, PA Tent, RI Juncar, A Harangus, M Rivis
DOI:10.4103/njcp.njcp_52_21  PMID:34782508
Background: Determining the etiology, epidemiology, pattern, and treatment of nasal bone fractures and the associated soft tissue injuries in a population will be beneficial for the prevention, rapid and correct diagnosis, and adequate management of this pathology in order to minimize postoperative complications. Patients and Methods: This study retrospectively evaluated the patients admitted and treated for nasal bone fractures in a university clinic of oral and maxillofacial surgery in Romania over a 10-year period. Following statistical analysis, evaluation and correlation of the monitored variables, a P value < 0.05 was considered statistically significant. Results: Nasal bone fractures had the highest incidence among men (88.30%), aged 20–29 years (33.33%), with no education (33.33%), interpersonal violence being the main cause in this category of patients (P = 0.004; P = 0.005; P = 0.005). In urban environment (55.9%), nasal bone fractures through aggression and road traffic accidents were predominant, while in rural areas (44.10%), those caused by domestic accidents and animal attacks prevailed (P = 0.551). Nondisplaced (81.10%), closed (85.60%) and involving the nasal septum fractures (51.35%) were preponderant. Hematoma was the most frequent associated soft tissue injury (86.49%), its incidence being increased in the case of displaced (P = 1.000) and open fractures (P = 0.692). The most frequent treatment method was close nasal reduction (CNR) + closed septoplasty (51.35%). The most frequent complication was malunion (7.2%), secondary to CNR without septoplasty (P = 0.037). Conclusions: The main etiology of nasal bone fractures was interpersonal violence, which mainly affected men, aged 20–39 years, with a low level of education, living in urban areas. Implementing laws to fight interpersonal aggression and increase the education level of the population would lead to a considerable reduction in the incidence of this pathology. Patients treated by CNR + closed septoplasty and ORIF had the best postoperative evolution. Immediate septoplasty in the case of associated septal fractures significantly decreased the rate of postoperative complications.
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Changes in stroke volume variation and cardiac index during open major bowel surgery p. 1682
SP Prabhu, A Nileshwar, HM Krishna, M Prabhu
DOI:10.4103/njcp.njcp_30_20  PMID:34782509
Background: Stroke volume variation (SVV) is a dynamic indicator of preload, which is a determinant of cardiac output. Aims: Aim of this study was to evaluate the relationship between changes in SVV and cardiac index (CI) in patients with normal left ventricular function undergoing major open abdominal surgery. Patients and Methods: Patients undergoing major open abdominal surgery were monitored continuously with FloTrac® to measure SVV and CI along with standard monitoring. Both SVV and CI were noted at baseline and every 10 min thereafter till the end of surgery and were observed for concurrence between the measurements. Results: 1800 pairs of measurement of SVV and CI were obtained from 60 patients. Mean SVV and CI (of all patients) measured at different time points of measurement showed that as SVV increased with time, the CI dropped correspondingly. When individual readings of CI and SVV were plotted against each other, the scatter was found to be wide, reiterating the lack of agreement between the two parameters (R2 = 0.035). SVV >13% suggesting hypovolemia was found at 207 time points. Of these, 175 had a CI >2.5 L/min/m2 and only 32 patients had a CI <2.5 L/min/m2. Conclusion: SVV, a dynamic index of fluid responsiveness can be used to monitor patients expected to have large fluid shifts during major abdominal surgery. It is very specific and has a high negative predictive value. When SVV increases, CI is usually maintained. Since many factors affect SVV and CI, any increase in SVV >13%, must be correlated with other parameters before administration of the fluid challenge.
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Comparison of stapled versus stapleless sleeve gastrectomy with natural orifice specimen extraction (NOSE) p. 1689
Serdar Kirmizi, Cuneyt Kayaalp, Servet Karagul, Ali Tardu, Ismail Ertugrul, Fatih Sumer
DOI:10.4103/njcp.njcp_388_20  PMID:34782510
Background: Sleeve gastrectomy is a stapler dependent bariatric procedure. A stapleless sleeve gastrectomy can be necessary for certain circumstances. Aims: Here, we aimed to show whether laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction (NOSE) can be an alternative procedure to stapled sleeve gastrectomy. Patients and Methods: In the stapleless group (n = 6), no staplers were used and after vertical resection of the stomach by energy devices, the stomach remnant was closed by two rows of intracorporeal sutures. The resected specimen was removed through the mouth using an endoscopic snare. In the stapler group (n = 7), sleeve gastrectomy was carried out with linear stapler under the guidance of 36 Fr bougie. The specimens were extracted from the left upper quadrant trocar site. Results: A total of 13 patients were compared (stapleless = 6 and stapled group = 7). All the sleeve gastrectomies were completed laparoscopically. The operative time was longer at 200 minutes (range 120-300) versus 120 minutes, (range 90-200) p = 0.07) and the amount of bleeding was higher at 100 ml (range 50-200) versus 30 ml (range 10-50) (p = 0.004) in the stapleless group. Leakage and gastrointestinal bleeding were seen in the stapleless group but no complications were found in the stapler group. No statistically significant difference was found between the metabolic outcomes of the two groups after the operation (p > 0.05). Decrease in BMI at similar rates was observed in 5 postoperative year (stapleless group: 35 kg/m2 (range 31-39) versus stapled group: 36.5 kg/m2 (range 31-39), p > 0.05). Conclusion: Laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction has longer procedure time, more blood loss and complications.
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The investigation of biochemical and microbiological properties of four different honey types produced in turkey and the comparison of their effects with silver sulfadiazine on wound healing in a rat model of burn injury p. 1694
S Pamak Bulut, M Gurbuzel, SN Karabela, HH Pence, S Aksaray, U Topal
DOI:10.4103/njcp.njcp_582_20  PMID:34782511
Background: To determine and compare the effects of different honey types on wound healing in an animal model, with silver sulfadiazine as the standard treatment. Materials and Methods: Five different groups were created with eight rats in each group. Partial-depth burns were created, and different types of honey and silver sulfadiazine were applied to the respective groups. Rats were monitored for 21 days, and wound cultures were obtained. Histopathological evaluation and cytokine analysis of final tissue samples were performed. In addition, the biochemical and microbiological analyses of the four types of honey used in the study were performed. Results: Wound shrinkage comparisons showed that all four honey-treated groups (Bingöl, Konya, cotton, and citrus) performed better than the silver sulfadiazine group (honey groups, respectively, 86.86%, 84.72%, 89.61%, and 95.33% vs. control 82.90%). However, only citrus honey caused a significant difference in wound shrinkage rate when compared with other groups as well with control group (95.34% vs. 82.9%, P < 0.05). In tissues, all honey groups had higher cytokine (interleukin [IL]-6, IL-1B, tumor necrosis factor [TNF]-α) values compared with controls (P < 0.001). Honey analysis showed a significant inverse relationship between Fe (iron) and the number of diastases. Conclusions: The results of this study support the role of honey in wound healing, due to its antibacterial and immunomodulatory effects. More studies are needed to identify the role of honey composition in wound healing.
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Prognostic utility of CURB-65 and E-CURB-65 scoring systems in healthcare associated pneumonia patients: Short- and long-term mortality p. 1706
E Kurt, R Ak, SZ Eke Kurt, S Bahadirli, B Nakis, T Cimilli Ozturk, EU Akoglu
DOI:10.4103/njcp.njcp_433_18  PMID:34782512
Background: The aim of our study is to evaluate whether the CURB-65 or expanded-CURB-65 score can be used in healthcare-associated pneumonia (HCAP) and subgroups of HCAP patients at the same efficiency. Thirty and 90-day mortality rates of the patients and predictive values of CURB-65 and E-CURB-65 scores were compared. Patients and Methods: This is a retrospective study of patients who presented to the Emergency Department between January 2015 and January 2016. All patient charts above 18 years of age were evaluated according to American Thoracic Society and the Infectious Diseases Society of America (ATS/IDSA) pneumonia diagnostic criteria and pneumonia diagnoses were confirmed. Results: 167 pneumonia patients (27.8%) of all pneumonia cases were grouped as HCAP and 433 (54.4%) were grouped as community-acquired pneumonia (CAP). 43% (n = 72) of HCAP patients were classified as nursing home-associated pneumonia (NHAP) and 57% (n = 95) were classified as HCAP (except NHAP) group. NHAP patients were older than the other groups. HCAP (except NHAP) group had somehow more comorbid diseases when compared with the other groups. However, the NHAP group had more unstable vital signs and confusion rates. Hospital and ICU admissions, 30–90-day mortality rates were all significantly higher in NHAP group E-CURB-65 was found to have better predictive values than CURB-65 for 30-day and 90-day mortalities overall. Conclusion: According to our results, commonly used scoring systems, CURB 65 and E-CURB 65, are not suitable for HCAP, NHAP, and HCAP (except NHAP) patients. NHAP patients have significant worse prognosis compared with CAP and HCAP (except NHAP) in terms of admission to intensive care and 30 and 90-day mortality rates.
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The psychometric properties of the turkish version of self rated abilities for health practices scale in the gestational diabetes sample p. 1712
NN Aypar Akbag, M Alus Tokat
DOI:10.4103/njcp.njcp_578_20  PMID:34782513
Background: The Self Rated Abilities for Health Practices (SRAHP) scale is an instrument devised for measuring an individuals' beliefs about self-efficacy for conducting health promotion practices. Using a valid and reliable scale while measuring the individuals' beliefs about self-efficacy may contribute to manage GDM. Aim: This study aims to evaluate the psychometric characteristics of the Self Rated Abilities for Health Practices Scale (SRAHP) among women with GDM in Turkey. Patients and Methods: This psychometric study used a cross-sectional study design. To culturally validate the Self Rated Abilities for Health Practices Scale (SRAHP), different techniques were utilized such as the blind back-translation technique, experts' opinions of the translated version, pilot study that individuals have similar characteristics and are not included in the study. The construct validity of the scale was tested to the exploratory factor analysis and confirmatory factor analysis. Item-total and item-subscale total score, Cronbach's alpha coefficients, and split-half reliability analyses were calculated for the internal reliability of the scale. Results: The explained rate of variance was 50.7%, and confirmatory factor analysis concerning the results was acceptable and in good fit. The results showed that the Cronbach's alpha coefficient for the whole scale was 0.91, and for subscales 0.88, 0.83, 0.80, and 0.68, respectively. Spearman-Brown (0.81) and Guttman Split-Half coefficients (0.80) were satisfactory for the whole scale. Conclusions: Turkish translation of the SRAHP scale was determined theoretically based, culturally acceptable instrument for the self abilities in women with GDM.
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Inappropriate drug use rates of geriatric patients attending to a university hospital cardiology policlinic p. 1719
YE Sari, I Unluoglu, Y Cavusoglu, U Bilge
DOI:10.4103/njcp.njcp_517_18  PMID:34782514
Background: The interest in risks related to inappropriate drug use (IDU) and polypharmacy among the elderly has increased in recent years. Aims: We aimed to determine the frequency of IDU and multiple drug use in elderly patients in the cardiology outpatient clinic. Patients and Methods: In this prospective, cross-sectional study, a total of 513 patients aged 65 years and above who were admitted to the Cardiology Policlinic between December 2017 and January 2018 were included. To determine the prevalence of IDU, we investigated the suitability of the drugs used by the patients (according to the criteria of Beers 2015 and Screening Tool of Older People's Prescriptions [STOPP] version 2), the number of violated criteria in both the guidelines and which criterion was violated by the inappropriate drugs. Results: The 513 patients (mean age: 73.18 ± 5.99) in this study included females (n = 235; 45.8%) and males (n = 278; 54.2%). A total of 2,910 drugs were used by the 513 patients (mean per patient: 5.67 ± 2.51); 52.8% of the patients were using more than five drugs. The Beers criteria revealed that 304 IDUs were detected among the drugs and showed that 38.6% (n = 198) of the patients had IDU. According to the STOPP criteria, 366 IDUs were identified among the drugs used, and 45.6% (n = 234) of the patients had IDU. Conclusion: IDU frequencies of the elderly patients are similar to the world literature in our study. As the number of chronic illnesses the patients had increases, the frequency of IDU increases according to Beers and STOPP criteria in our study.
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Evaluation of the marital adjustment and sexual functions in individuals with visual disability p. 1728
E Gozuyesil, KS U Aslan, D Atik, E Tar
DOI:10.4103/njcp.njcp_679_19  PMID:34782515
Background: Sexuality is an important component of marriage. Individuals with visual disability tend to experience more sexual problems, which could deteriorate their marriage relationships and cause difficulties in establishing and maintaining sexual relationships. Aims: This study aims to evaluate marital adjustment and sexual functions in individuals with visual disability. Subjects and Methods: The sample of this descriptive study consisted of 95 individuals with visual disability who were members of a relevant private association in Turkey and met the inclusion criteria. The sample size was calculated using the sample with a known population approach. Data were collected using the Sociodemographic Form, the Marital Adjustment Scale (MAS), and the Golombok–Rust Inventory of Sexual Satisfaction (GRISS). The data were analyzed using the Mann–Whitney U test, Kruskal–Wallis test, Dunn's test, and the Spearman's Rho Correlation Analysis.Results: The mean scores for the MAS and the GRISS were 48.0 (23–60) and 51.5 (17–72), respectively. There was a statistically significant difference between the mean scores of individuals with visual disability and their spouses in the MAS by their age (P < 0.05). The subscales of the GRISS (except for frequency and communication) indicated that men with visual disability had problems regarding impotence, premature ejaculation, sensuality, avoidance, and satisfaction subscales. There was a statistically significant and negative relationship between the marital adjustment total scores of the males with visual disability and their scores in the avoidance, satisfaction, frequency, and communication subscales (P < 0.05; P < 0.01). Conclusion: The participants were found to have good marital adjustment. However, males with visual disability had a low level of sexual problems.
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Comparison of histopathological findings of the colon adenomas and adenocarcinomas with cyclin D1 and Ki-67 expression p. 1737
D Ayerden, M Tayfur, MG Balci
DOI:10.4103/njcp.njcp_68_21  PMID:34782516
Background: Cancer is one of the biggest health problems in the world. Colon adenocarcinoma is the third most common cancer and is the fourth most common cause of cancer deaths. The majority of colon adenocarcinomas originate from a previous adenoma. Cyclin D1 expression and Ki-67 proliferation index increase as the risk of malignancy transformation increases in adenomas. Aims: This study aims to share the results of the Cyclin D1 and Ki-67 studies we performed in colon adenoma and colon adenocarcinoma cases in our hospital with the literature and contribute to the diagnosis and treatment of patients. Materials and Methods: Surgical materials of 40 colon adenocarcinomas and 40 colon adenomas were histopathologically re-evaluated. Cyclin D1 and Ki-67 immunohistochemical staining were applied to these materials. Cyclin D1 and Ki-67 staining rates were compared in colon adenocarcinomas and adenomas. Results: Cyclin D1 and Ki-67 staining rates were increased in colon adenocarcinoma cases compared to colon adenoma. There was a significant difference between the colon adenocarcinoma and colon adenoma case groups in terms of Cyclin D1 and Ki-67 staining scores. Conclusion: In conclusion, immunohistochemical markers such as Cyclin D1 and Ki-67 will be helpful in differential diagnosis when there is difficulty in evaluating routine Hematoxylin-Eosin stained preparations between adenocarcinomas and adenomas.
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Evaluation of the effect of bruxism on mandibular cortical bone using radiomorphometric indices on panoramic radiographs p. 1742
I Eninanc, D Yalcin Yeler, Z Cinar
DOI:10.4103/njcp.njcp_71_21  PMID:34782517
Background: This prospective study was designed to evaluate the effects of bruxism on mandibular cortical bone using radiomorphometric indices on digital panoramic radiographs. Materials and Methods: The mandibular cortical index (MCI), mental index (MI), and panoramic mandibular index (PMI) were measured on digital panoramic radiographs and evaluated for 128 bruxers (66 female, 60 male) and 128 control subjects. The data were analyzed statistically using intraclass correlation coefficients (ICC), Kappa statistics, Chi-square test, Kolmogorov–Smirnov test, independent t-test, and Pearson's correlation analysis. Results: There was no difference between the groups in terms of MCI type (P > 0.05). While mean MI values were significantly higher in bruxers than the control group (P = 0.007), the difference between groups in mean PMI values was nonsignificant (P > 0.05). In both groups, the C1 type was more prevalent in females than in males (P = 0.001). Females showed significantly lower mean MI values than males in both groups (P ≤ 0.040). However, the difference between genders in mean PMI values was not significant (P > 0.05). Conclusions: MI measurements may be useful when radiomorphometric indices are to be used for the diagnosis or follow-up of bruxism in the mandible. Among radiomorphometric indices, MI and MCI values are affected by gender differences.
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Management of a huge intrathoracic goitre in a rural specialist hospital in Nigeria–Case report and review of literature p. 1749
AA Okomayin, A Dongo, E Tagar, C Odion, M Akerele, F Omosofe
DOI:10.4103/njcp.njcp_101_21  PMID:34782518
Retrosternal goiter is expectedly a common presentation in rural African communities due to long periods of neglect. The treatment of choice is surgical – commonly via a trans-cervical incision. A few require an extra-cervical surgical approach and multidisciplinary management as reported in this case performed in a rural specialist hospital in Nigeria.
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Mandibular neurofibroma with osseous deformities in a 3-year-old child with neurofibromatosis type 1: A case report presentation and diagnosis p. 1755
AY Aloyouny, HN Albagieh, AS Alweteid, MA Alsheddi
DOI:10.4103/njcp.njcp_421_20  PMID:34782519
Neurofibromatosis type 1 (NF1) is a rare autosomal dominant genetic disorder. It is a multisystem neurocutaneous condition represented by multiple benign tumors of the nerves and skin known as neurofibromas and cafe' au lait spots. However, neurofibroma localized in the mandible is rare. We present a case of a 3-year-old, Egyptian girl with NF1. The girl presented with right mandibular swelling of undetermined duration and multiple hyperpigmented spots on the skin. This case report shows the important role of dentists, as demonstrated in the present case, in the diagnosis and management of this disease, since the diagnosis was made during dental consultation and subsequently managed by the team.
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Erratum: Prevalence of refractive errors and visual impairment in school children in Enugu SouthEast Nigeria p. 1758

DOI:10.4103/1119-3077.330481  PMID:34782520
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