Venous thromboembolism is a significant cause of mortality and morbidity in patients following major orthopaedic surgeries. The RECORDS 3 trial revolutionised anticoagulation practice especially in patients with total knee arthroplasty and challenging the strong hold of warfarin and heparin in anticoagulation practice. With all these novel agents shifting the paradigm in anticoagulation management, Cost, in accessibility and lack of awareness of the availability of the agents amongst clinicians and surgeons alike are some factors militating against the use of these agents in patients in resource poor countries.

Background and Objective: A postextraction comparative (cohort) study was carried out to determine whether the number of teeth extracted has an effect on salivary cortisol and by extension on stress. Subjects and Methods: Sixty-three consecutive patients comprising 27 males (42.9%) and 36 females (57.1%) with a male: female ratio of 1:1.3, divided into two groups of A and B with a mean age of 25.8 ± 4.9 years, and age range of 18–37 years took part in the study. Fifty (79.4%) of them in group A (22 males and 28 females) each had a tooth extracted while 13 (20.6%) in group B (5 males and 8 females) had two teeth removed. One ml of resting saliva was collected from each patient 10 minutes after the procedure and analyzed for cortisol. All extractions and sample collections were done between 10 am and 2 pm to standardize the study and control for the diurnal variation of cortisol. Statistical analysis of the generated data was performed by using Student's t-test on SPSS version 17.0. The level of significance was set at 0.05 with P< 0.05 regarded significant. Result: The result showed mean salivary cortisol level of 12.914 ± 2.4684 ng/ml for group A and 12.108 ± 1.7192 ng/ml for group B though not statistically significant (P > 0.05). Females had more extractions in the two groups when compared with males. Male gender had a statistical significance difference (P < 0.05). Conclusion: This study shows that the number of teeth extracted did not have effect on mean salivary cortisol, as a result two teeth extraction does not impart more stress to the patient when compared with one, and as such no additional adjuvant stress relieving measures are needed in two teeth extractions.

Purpose: The aim of this study was to analyze the blood glucose (BG) variations in cancer patients during chemotherapy according to tumor types and chemotherapeutic regimens. Materials and Methods: Patients were examined from the Department of Medical Oncology of Cancer Hospital and Institute, Chinese Academy Medical Sciences from January 2012 to December 2014. The patients' ages, genders, body mass index, associated disease history, and corresponding BG values were recorded. Results: Among these 2029 patients, 331 (16.3%) patients encountered high BG during chemotherapy except diabetic patients. Of these patients, 208 (62.8%) were males, and 123 (37.2%) were females, with age ranged from 17 to 84 years. The 331 cases included 23 tumor types and 77 regimens. Totally, BG values increased up to 7.4 ± 1.3 mmol/L during chemotherapy. Conclusions: No previous studies in the literature have examined systematically so numerous cases of hyperglycemia during chemotherapy. This study has pointed out possible high-risk chemotherapeutic regimens and tumor types, which should be paid attention to prevent the occurrence of hyperglycemia.

Background: Anemia in the peripartum or postpartum period could pose a significant risk for maternal morbidity and mortality during and after delivery. Aims: To determine the rates of anemia at term and in the puerperium and describe the determinants of puerperal anemia among a cohort of women with both normal and cesarean deliveries, following uncomplicated term singleton pregnancies in Enugu, Nigeria. Methods: A prospective longitudinal study involving women with uncomplicated singleton pregnancies who were recruited at term at two tertiary maternity centers and were followed up with the determination of hemoglobin and ferritin concentrations till 6 weeks after delivery. Data were analyzed with descriptive and inferential statistics at 95% level of confidence using the Statistical Package for Social Sciences computer software version 20.0 for Windows (IBM Corporation, Armonk, NY, USA). Results: A total of 202 women were studied. The mean hemoglobin levels at term, 48 h, and 6 weeks postpartum were 11.1 ± 0.9 g/dL, 10.5 ± 0.8 g/dL, and 11.2 ± 1.0 g/dL, respectively. The proportions of women with anemia at term, 48 h, and at 6 weeks postpartum were 46.0%, 72.8%, and 47.5%, respectively. Forty-eight hours postdelivery, 17.3% had anemia with low serum ferritin compared to 7.4% by 6 weeks postdelivery. Anemia at term (adjusted odds ratio [aOR] 2.02; 95% confidence interval [CI] 1.01, 4.05), anemia at 48 h postdelivery (aOR 6.17; 95% CI 3.30, 11.6), and low ferritin at 48 h postdelivery (aOR 3.11; 95% CI 1.51, 5.09) all increased the likelihood of anemia at 6-week postpartum. Conclusions: A high proportion of low-risk pregnant women in the study centers could go through delivery with undetected anemia and this would predispose to high rates of postpartum anemia. Screening of low-risk women at term and in the immediate postdelivery periods may be necessary to improve detection of such cases.

Objectives: The aim of this study is to evaluate the prevalence and type of temporomandibular disorders (TMD) in patients with rheumatoid arthritis (RA). Materials and Methods: Fifty-four patients having RA treatment at Cukurova University in Rheumatology Clinic were enrolled to the study. Demographic and rheumatologic data were recorded. The patients were examined in Dental Faculty by using Research Diagnostic Criteria/TMD (RDC/TMD) axis I and answered RDC/TMD axis II Biobehavioral Questionnaire. Data were evaluated according instructions for scoring and assessment of RDC/TMD. Mann–Whitney test was performed to compare continuous variables between two groups and Kruskal–Wallis test was performed to compare continuous variables for more than two groups. Results: Although their activity situations were 55.6% active and 44.4% inactive, the distribution of treatment modality was 31.5% for anti-tumor necrosis factor-α (TNF-α) and 68.5% for disease-modifying antirheumatic drugs (DMARD). The distribution of temporomandibular joint (TMJ) involvement was; 9.3% with no involvement, 7.4% with joint involvement, 64.8% with muscular involvement, 18.5% with both muscular and joint involvement. Rheumatologic functional scores were (0) 3.7%, (1) 50%, (2) 38.9%, (3) 7.4%. Patients' chronic pain was graded from 0 to 4 and the distribution was 3.7%, 24.1%, 20.4%, 31.5% and 20.4%, respectively. The mean duration of RA for anti-TNF-α (11.47 ± 7.67) was significantly higher compared with DMARD (7.09 ± 5.21) P = 0.040. Conclusion: There was a high prevalence of TMD in RA patients, and muscular involvement was the highest among the TMJ involvements. Thus, this study supports TMJ examination should be encouraged in the rheumatology settings.

Background: Nonclinical factors are said to influence decisions to admit patients into the Intensive Care Unit (ICU). We therefore assessed the perception and attitude of Nigerian doctors working in the ICU about inappropriate admissions and request for admission in the setting of a full ICU. Methods: An anonymous, self-administered questionnaire survey was carried out among doctors working in the ICU of 17 University Teaching Hospitals, in Nigeria. A score of 0 (least usual reason) to 5 (most usual reason) was ascribed to some factors that can influence ICU admission. In addition, each of the 4 possible actions in the setting of a full ICU was graded from 0 (least likely) to 5 (most likely). The result was analyzed as appropriate. Results: Sixty-four doctors participated in the survey. Inappropriate admissions were acknowledged by 96% of respondents. Perceived reasons included pressure from superiors (93.7%), referring clinicians (89.1%), and hospital management (87.5%). If confronted with request for admission in the setting of a full ICU, respondents will arrange for the discharge of fit ICU patients to the ward (95.3%), transfer patients not receiving acute care to high dependency unit or recovery room (70.3%), or create additional ICU beds (42.2%). Chi-square test showed a significant difference between single and married respondents with regard to clinical doubt (P = 0.01) and pressure from referring clinician (P = 0.02) as reasons for inappropriate admission. Respondents' gender, marital status, professional activity, and number of ICU admissions per year did not affect possible steps in the setting of a full ICU. Conclusion: Inappropriate ICU admissions were perceived as a common event and were mainly attributed to pressure from seniors, referring clinicians, and hospital management. Further work is necessary to determine the impact of such admissions on ICU efficiency.

Objective: The role of Angiopoietin 2 (Ang 2), which is necessary for tumor growth, extension, and metastasis is not fully elucidated. The presented study aimed to investigate the relationship between Ang 2 staining intensity, expression rate in tumor tissue, and the stage of lung cancer. Materials and Methods: Fifty cases of lung cancer (34 non-small and 16 small cell cases) were included in the study. Immunohistochemistry was done to evaluate Ang 2 staining intensity and expression rate in tumor and stromal cells of lung cancer tissue. Results: Ang 2 was positive for 45 (90%) cases and negative for five (10%) cases (P = 0.04). There was a significant correlation between Ang 2 expression rate of expression and the histologic type of lung cancer (P = 0.033). Ang 2 expression rate in tumor cells of cancer tissues diagnosed with adenocarcinoma was low. There was a significant correlation between Ang 2 expression rate in stromal cells of cancer tissue and the type of lung cancer (P = 0.021). Stromal cell expression rate of Ang 2 in adenocarcinoma was found to be low. Conclusions: As a result, the relationship between lung cancer stage and Ang 2 was documented with this study and the expression rate was found to be lower in adenocarcinomas. By this analysis, we can suggest that angiopoietins may be used as an option for targeted treatment in lung cancer.

Introduction: The resistance of three different substructure materials – metal (Cr-Co), zirconium (Zr), and ceramics (IPS Empress II) – was measured by sticking them to dentine with two different resin cements, a dual-cure resin cement (Panavia F 2.0 Light) and a self-adhesive resin cement (BisCem). Materials and Methods: In an in vitro study, 72 central upper front teeth were selected with no decay or apparent breakage and with complete development, removed for periodontal reasons. Labial and incisal surfaces of all teeth were prepared. Molds were obtained to prepare metal (Co-Cr), Zr, and ceramic (IPS Empress II) blocks for use in the study. The compressive strengths of the obtained material infrastructures were examined after thermal cycle processing by performing cementation to the teeth with two different cements. The data obtained were analyzed statistically. The Mann–Whitney U-test was used for comparisons of the groups with two options, and Kruskal–Wallis variance analysis was used to compare more than two groups. P<0.05 were considered statistically significant. Results: While the highest result between samples was 117.86 ± 47.94 N in the dual-cure (Panavia)-ceramic group, the lowest value was observed at 6.53 ± 3.12 N in the self-adhesive (BisCem)-metal group. There was a significant difference between dual-cure (Panavia) and self-adhesive (BisCem) groups. Conclusion: In this study, we measured the bond strength; our most durable resistance groups were found to be, in order, Panavia-ceramics >Panavia-metal >Panavia-Zr >self-adhesive-ceramics >self-adhesive-Zr >and self-adhesive-metal.

Background: Preterm premature rupture of membranes (PPROM) is a challenging complication of pregnancies and an important cause of perinatal morbidity and mortality. Management of morbidities associated with PPROM is fraught with controversy. However, women should be informed of these complications. Objective: This article aimed to review the morbidities, concordance, and predictors of PPROM over a 10-year period. Methods: This was a retrospective review of morbidities, concordance, and predictors of PPROM among pregnant women at the University of Nigeria Teaching Hospital, Enugu, Nigeria between January 1, 1999, and December 31, 2008. The morbidities, concordance, and predictors of PPROM were expressed by regression analysis output for PPROM. Results: Primigravidae had the highest occurrence of PPROM. Increasing parity does not significantly influence the incidence of PPROM. The concordance and predictors of PPROM are maternal age (P < 0.000), gestational age at PROM (P < 0.000), latency period (P < 0.000), and birth weight (P < 0.001). Conclusion: PPROM is a major complication of pregnancies and an important cause of perinatal morbidity and mortality. Management of these morbidities associated with PPROM poses a great challenge. However, women should be informed of these complications.

Aim: Intraoperative blood glucose concentration is known to be an independent risk factor for morbidity and mortality in patients undergoing cardiovascular surgery. Arterial blood gas analysis is an important investigation to monitor the acid-base balance and gas exchange in these patients. Hyperglycemia leads to a series of metabolic changes which affect acid-base balance and serum electrolytes. In this study, we aimed to look into the effect of glycemic control on arterial blood gas parameters, serum electrolytes, and hemoglobin (Hb). Materials and Methods: We collected data from diabetic patients who underwent cardiovascular surgery between 2010 and 2014. The patients were divided into two groups according to the insulin infusion protocols applied such as with conventional (180–250 mg/dl) (n = 17) (Group 1) and tighter glycemic targets (121–180 mg/dl) (n = 51) (Group 2). We retrospectively analyzed arterial blood gas results taken at different perioperative time points from these patients. Results: We found that pH HCO₃and base excess, serum sodium, potassium, calcium, and Hb were similar in both groups. Conclusion: Our study showed that a tighter intraoperative glycemic control does not affect arterial blood gas parameters, serum electrolytes, or Hb when compared to the conventional glycemic control.

Purpose: The aim of this study was to investigate the characteristics of the analgesic effect of diclofenac sodium injected epidurally in single or repeated doses and whether tolerance develops in long-term use. Materials and Methods: A total of 30 rats were included in the study. The rats were anesthetized using intraperitoneal ketamine hydrochloride and an epidural catheter (EC) was inserted at the level of 13^th dorsal thoraco-lumbar vertebrae (T13). Eleven rats were excluded from the study. The remaining 19 rats were randomly divided into three groups; Group Control (Group C) (n = 6) received 20 μL normal saline solution (NS) via EC for 10 days; Group Single Dose (Group SD) (n = 6) received 20 μL NS for 9 days and 6 μg diclofenac via EC on 10^th day; Group Ten Doses (Group TDs) (n = 7) received 6 μg diclofenac via EC in 20 μL NS for 10 days. On the 10^th day, 30 min after epidural diclofenac sodium, 300 mg/kg of 3% acetic acid was injected via intraperitoneal route, and the rats were observed for 30 min and number of writhing reflex (WR) was recorded. Results: The values of total number of Writhing Reflex (WRT) and Writhing reflex per minute(WR/min) were found to be significantly higher in Group C compared with Groups SD and TD (P = 0.009). Conclusion: Single and repeated doses of diclofenac sodium via epidural route have an analgesic effect in a visceral pain model in rats without developing tolerance.

Aim: The use of a simple and reproducible model is inevitable for an objective statement of the effects of external factors on wound healing. Hence, the present study was conducted to evaluate wound healing activities of sequential different extracts of Aegle marmelos leaves (AM) and Mucuna pruriens seeds (MP) by in vivo experimental models. Materials and Methods: Wistar albino rats were subjected to excision, incision and dead space wounds measuring approximately 250 mm², 3 cm and implanting sterilized polyvinyl chloride tube on the back of each rat near either side of the vertebral column respectively. The experimental animals were randomized into eight groups (n = 6), control, standard and treatment groups. Hydrogel of different extracts were applied topically once daily. The parameters observed were percentage of wound contraction, epithelization period, tensile strength, hydroxyproline content of the granulation tissue, and histological changes during wound healing. Results: The statistical study revealed that in excision, incision, and dead space wound models all formulations have significant (P < 0.01) wound healing potential. However, methanolic extract formulation was found to be superior to all other treatments as evidenced by rapid wound contraction, lesser number of days required for complete epithelization, increased tensile strength and significant increase in hydroxyproline content. Conclusions: As compared to the reference standard treated group the wound healing process of the experimental groups was decelerated. All extracts obtained from AM and MP facilitated the wound healing process in all experimental models.

Introduction: The purpose of this study is to assess and compare the discriminatory ability of the Glasgow coma scale (GCS)-age-systolic blood pressure (GAP) score and modified early warning scoring system (mEWS) score for 4-week mortality, for the patients being in the triage category 1 and 2 who refer to Emergency Department (ED). Methods: Five hundred and two nontraumatic cases being in the triage category 1 and 2 who were ≥18-year-old and who referred to ED were assessed prospectively. Reason of referral, fashion of referral, age, gender, vital signs, GCS/alert/verbal/painful/unresponsive scores, consultations, diagnoses, and treatments and final outcome (hospitalization, transfer, discharge, treatment rejection, and exitus) were recorded. The mEWS and GAP scores and the mortality ratios of the cases were calculated by observing both in ED and 4-week survivals of the patients. Results: When the mEWS and GAP scores were compared in the prediction of 4-week mortality, no statistically significant difference was found between them (P > 0.05). The power of mortality estimation was found significant for both scoring systems (for both; P< 0.001). Conclusion: GAP score with a simple use being a score developed for the estimation of mortality of trauma patients seems to be usable also for the nontraumatic patients with triage category 1–2 in the ED.

Objectives: This study evaluated the microtensile bond strength (μTBS) of a resin composite bonded to bleached enamel as a function of bleaching conditions. Materials and Methods: The whiteness hydrogen peroxide (HP) bleaching agent containing 35% HP was applied to the central incisors' facial enamel surface and irradiated as follows: No treatment (G1; control); no light (G2); light-emitting diode, the 40s (G3); diode laser, the 20s (G4); and neodymium:yttrium aluminum garnet laser, 20s (G5). A Variolink II resin composite structure was then built up incrementally on the surface. The teeth were sectioned into three 1.2 mm × 1.2 mm wide “I”-shaped sections. The specimens were then subjected to microtensile testing at a crosshead speed of 1 mm/min. Data were analyzed using one-way ANOVA (α =0.05) followed by the Tukey Honestly Significant Difference post-hoc test. The fractured surfaces were observed with a stereomicroscope at × 100 magnification. Results: One-way ANOVA revealed no statistical differences among the groups (P > 0.05). No differences appeared between the groups bonded 14 days after bleaching (P > 0.05). Mean μTBS values (MPa) were as follows: 22.05 ± 5.01 (G1); 19.6 ± 5.6 (G2); 19.3 ± 5.4 (G3); 20.08 ± 2.08 (G4); and 18.1 ± 4.8 (G5). Many adhesive failures occurred at the bleached and irradiated enamel surfaces. Conclusion: The various irradiation treatments following the application of the whiteness HP bleaching agent to enamel did not significantly reduce the μTBS within a 14-day period.

Context: Antenatal care utilization has been shown to be associated with reduction in maternal and perinatal morbidity and mortality while early initiation provides an opportunity for optimum utilization of this care with improved maternal and fetal outcomes. Aim: This study seeks to determine the time of initiation of antenatal care among pregnant women and possible factors influencing such timing. Setting: A cross-sectional study involving 530 pregnant women was carried out at the booking clinic of the Ekiti State University Teaching Hospital, Ado-Ekiti, between September 03, 2013, and March 04, 2014. Subjects and Methods: A pretested questionnaire was administered to them to obtain information on their sociodemographic characteristics and factors influencing their timing of antenatal care initiation. Results: The prevalence of early booking in this study was 22.7%, and the mean gestational age at booking was 21.09 ± 6.98 weeks. The age, parity, and occupation of the women and counseling on early booking were significantly associated with early booking among the respondents with P value of 0.010, 0.006, 0.011, and 0.009, respectively while on logistic regression, the occupation of women was the only significant association with early antenatal care initiation (adjusted odd ratio 0.388; confidence interval 0.212–0.710; P = 0.002). Complications experienced in previous pregnancies did not predict early initiation of care. More than half of the respondents (50.9%) gave early monitoring of their pregnancy as the reason for initiating the care. Conclusion: Late initiation of antenatal care is still prevalent in our environment. Therefore, pregnant women should be adequately informed about the concept of early antenatal registration.

Context: Uremic cardiomyopathy is a risk factor of end-stage renal disease (ESRD) and is responsible for high mortality rates and increased left ventricular mass index (LVMI). Macrophage migration inhibitory factor (MIF) promotes inflammation and is an important factor in uremic cardiomyopathy. Aims: The aim of this study is to investigate the effects of serum macrophage MIF on myocardial hypertrophy in ESRD patients and to examine the relation of this factor to clinical characteristics. Settings and Design: One hundred forty-four patients with chronic kidney disease (CKD) were divided into three groups: (1) CKD, (2) peritoneal dialysis (PD), and (3) hemodialysis (HD) groups. A control group included subjects without kidney disease. Serum macrophage migratory inflammatory factor was measured using the Bio-Plex cytokine assay and LVMI was measured. Subjects and Methods: MIF was determined using the Bio-Plex cytokine assay. LVMI was calculated by color Doppler ultrasound measurements. Statistical Analysis Used: Statistical analyses to compare data among groups included: The Kruskal–Wallis test to measure skewness of data and Spearman's rank correlation test to measure associations among continuous and ordinal variables. Logistic regression analysis was performed to determine relative risk. Results: Serum macrophage migratory inflammatory factor levels were higher in HD patients (982.74 pg/mL) than that of PD patients (762.20 pg/mL), CKD patients (755.66 pg/mL), or healthy controls (336.81 pg/mL) (P = 0.009). Levels were also significantly increased in patients with left ventricular hypertrophy, and they correlated with the levels of other inflammatory factors. Conclusions: This study suggests that macrophage migratory inflammatory factor promoted the occurrence and development of uremic cardiomyopathy in patients with ESRD.

Aim: To investigate the percentage of patients with Type 2 diabetes mellitus (T2DM) who achieved simultaneous control of glycated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) and also to assess its determinants in Shaanxi province, North-Western China. Materials and Methods: This cross-sectional survey was conducted between March and June 2012 in six tertiary hospitals across Shaanxi province. Subjects with known T2DM who had at least one antidiabetic medicine were invited. A questionnaire was used to collect basic information and blood samples were drawn for laboratory measurements. Simultaneous control was defined as HbA1c <7%, BP <130/80 mmHg, and LDL-C <2.6 mmol/L. Results: A total of 2274 individuals were included, of which 588 individuals (25.9%) achieved good glycemic control (HbA1c <7%) and only 102 (4.5%) attained simultaneous control. The percentage of individuals (24.2%) achieving simultaneous control increased with less stringent goals (HbA1c <8%, BP <140/90 mmHg, and LDL-C <2.8 mmol/L). In addition, multivariate analyses showed that body mass index of 24–28 kg/m² (odds ratio [OR]: 0.577, 95% confidence interval [CI]: 0.376–0.886), HbA1c above 8% at diagnosis (pooled OR: 0.392, 95% CI: 0.254–0.531), and insulin treatment (pooled OR: 0.412, 95% CI: 0.225–0.594) were the independent predictors of simultaneous control. Conclusion: Simultaneous control among drug-treated Type 2 diabetes patients was amazingly low in North-Western China. Our present study confirmed the gap between guideline and practice and provided evidence of the need for aggressive diabetes management.

Background: The metabolic syndrome is closely related to insulin resistance (IR) and cardiovascular disease. This study examined the prevalence of IR and metabolic syndrome as well as factors associated with IR among Nigerian women. Materials and Methods: Eighty-six women living in an urban area in Enugu, South-East Nigeria, were assessed. Demographic information included age, residence, physical activity, alcohol and tobacco intake and were collected with questionnaires. Blood pressure and anthropometric parameters were measured using standard methods. Fasting lipids, blood glucose, and insulin were measured. IR was calculated with homeostasis model assessment of IR formula. The ratios; triglyceride/high-density lipoprotein (TG/HDL), total cholesterol (TC)/HDL, and atherogenic index of plasma; log (TG/HDL) were calculated and compared with IR. Metabolic syndrome was sought for using both the WHO and the harmonized joint criteria. Results: The mean age was 44.4 (13.1) years. Hypertension, obesity/overweight, and abdominal obesity were present in 31.5%, 81.1%, and 92.2%, respectively. There was elevated TC (62.2%), elevated low-density lipoprotein (45.6%), low HDL (40%), and elevated TG (14.4%) levels. IR was present in 39 (45.3%). Metabolic syndrome was present in 25 (29.1%) and 17 (19.8%) using the joint criteria and the WHO criteria, respectively. The sensitivity and specificity of the joint revised criteria in identifying IR individuals were 48.7% and 87.2%, respectively, and for the WHO criteria, were 38.5% and 95.7%, respectively. The only significant predictor of IR was the presence of diabetes; P = 0.03, odds ratio = 7.2 (95% confidence interval = 1.19–41.88). Conclusion: IR and metabolic syndrome were common. They were not related to any of the lipoprotein ratios. Metabolic syndrome had a low sensitivity in detecting IR.

Background: Sexual dysfunction is common in patients receiving psychotropic medications and may reduce their quality of life and medication adherence with resultant negative impact on treatment outcomes. Objectives: In this study, we described the various types of sexual dysfunction among psychiatric outpatients receiving psychotropic medications and the sociodemographic and clinical correlates associated with it. Settings and Design: A descriptive, cross-sectional study conducted in a Neuropsychiatric Hospital in Northern Nigeria. Methodology: The participants were made up of a consecutive sample of 255 outpatients attending psychiatric clinic from January to March 2014. Data were collected on sociodemographic items, patient's clinical diagnosis, psychotropic medications received, and duration of treatment. Information about sexual functioning was obtained using the International Index of Erectile Function Questionnaire for the male participants and the Female Sexual Function Index for the female participants. Results: The mean age of the patients studied was 34.7 years (standard deviation [SD] =5.9), with a mean duration of treatment of 3.8 (SD = 6.5) years. Males constituted 47.8% and patients with schizophrenia constituted 43.1%; other diagnoses include bipolar affective disorder, recurrent depressive disorder, and substance use disorder. The prevalence of sexual dysfunction was 64.3%. Age, employment status, and psychotropic medication use were significantly associated with sexual dysfunction; however, only employment status and psychotropic medication use significantly predicted sexual dysfunction. Conclusions: We concluded that sexual dysfunction is highly prevalent among patients receiving psychotropic medication; as such inquiries about sexual function should be routinely carried out by clinicians as this may negatively impact on adherence and quality of life.

Background: It is known that no specific antifungal agent exists at present for irrigation of infected root canals. QMix 2in1 was investigated to determine whether they could be an alternative for sodium hypochlorite (NaOCl), chlorhexidine gluconate (CHX), and ethylenediaminetetraacetic acid (EDTA). Objective: The aim of this in vitro study was to evaluate and compare the antifungal efficacy of QMix 2in1, 5.25% NaOCl, 2% CHX, and 17% EDTA as a final rinse against Candida albicans (C. albicans). Materials and Methods: Ninety single-rooted mandibular premolar teeth were randomly divided into four experimental (n = 20) and two control (n = 5) groups. All root canals were instrumented with Mtwo rotary file system using crown-down technique to an apical size 40. Following root canal preparation, teeth were inoculated with C. albicans and incubated for 72 h. Teeth were irrigated with one of the following solutions as a final irrigant: (1) 5.25% NaOCl, (2) 2% CHX, (3) QMix 2in1, and (4) 17% EDTA. Aliquots from the samples were plated on 4% Sabouraud Agar, and colony-forming units were counted. Results: QMix 2in1, 5.25% NaOCl, and 2% CHX were equally effective (P > 0.05) and significantly superior to 17% EDTA in eradicating C. albicans (P < 0.05). Conclusion: QMix 2in1 proved to be effective against C. albicans when used as a final rinse. According to the findings of the present study, QMix 2in1 may be recommended as an alternative final rinse solution.

Background: Cranial neuroendoscopy has been safely applied to the surgical treatment of different lesions of the brain in our center since its introduction in September 2009. This article summarizes our experience with neuroendoscopy, highlighting the salient challenges and outcome. Methods: A single institution, retrospective analysis of prospectively acquired cases over a 2.5-year period (September 2010 to February 2013). Challenges experienced during the course of patient care as well as complications and outcomes were recorded and analyzed using SPSS (SPSS Inc. Chicago IL, USA) version 17. Tests of statistical significance were set at 95% level. Results: Of the 291 cranial procedures performed during the study period, 37 (12.7%) were neuroendoscopic interventions. Patients were between the ages of 0.25 years and 25 years with a mean of 5.7 ± 1.5 years (95% confidence interval (CI)). Aqueductal stenosis was the most common indication for endoscopic intervention in 22 (59.5%) patients. Endoscopic third ventriculostomy was the most commonly performed neuroendoscopic procedure in 21 patients (56.7%). Major challenges experienced were patient dependent in 28 ± 1.0 patients (95% CL), learning curve related in 21 ± 0.4 patients, and poor endoscopy support infrastructure in 15 ± 0.5 patients. Complications were significantly more common in the first 6 months of neuroendoscopy (χ²= 7.57, df = 1, P< 0.05). Overall, 30 (81.1%) patients in our study experienced a positive outcome. The permanent morbidity and mortality rates in our series were 2.7% and 8.5%, respectively. Conclusion: Highlighted are the myriad obstacles which interface the successful set up of neuroendoscopy service especially in resource-constrained settings. Endoscopic procedures become safer with experience and complications reduce significantly after a steep learning curve.

Background: Preoperative fasting of patients aims to reduce the residual gastric volume (RGV). The magnitude of this reduction is yet to be ascertained in the Nigerian population. Aim: To compare the RGV and pH of patients fasted for 6–12 h with those allowed oral intake of fluid up to 2 h preoperatively. Subjects and Methods: This randomized study involved 90 American Society of Anesthesiologists physical status I–II patients booked for abdominal myomectomy under general anesthesia. The patients were randomized into three groups. Preoperative fasting from midnight (Group F, n = 30) was fasted from midnight to the operation time. Carbohydrate-rich drink group (Group C, n = 30) received 800 mL of oral carbohydrate solution in the evening before surgery (22:00 h). An additional 400 mL was given 2 h before anesthesia. Placebo drink group (Group P, n = 30) received water in the same protocol as Group C. The Student's t-test was used to analyze RGV and pH postoperative satisfaction and postoperative nausea and vomiting (PONV) were compared on a visual analog scale. Results: The RGV and pH were similar for all groups (P = 0.45 and 0.90, respectively). Antiemetic consumption and PONV scores were lower in Group C compared with Groups F and P (P = 0.01). Patients' in Group C had higher satisfaction (P < 0.001). Conclusion: Preoperative carbohydrate or water intake up to 2 h before surgery is safe with better satisfaction when compared to overnight fasting.

Background: Surgical site infections (SSIs) in spine surgery remain a significant cause of morbidity and prolonged hospitalization. Factors affecting SSI includes patient's comorbidities, duration of surgery, type and indication for surgery among others. We intend to document our experience in our center and highlight possible factors influencing SSI in posterior spine surgery. Methodology: All consecutive patients who had posterior spine surgeries between January 2012 and July 2014 were recruited into the study. All patients who had wound infection were noted and culture sensitivities were documented as well. Results were analysed to get the infection rate, reasons for prolonged stay on admission as well as possible contributing factors to wound infections. Results: A total of 62 patients' records were reviewed with 34 males and 28 females (male:female = 1.2:1). SSI was classified as deep or superficial to the fascia. Ten (16.1%) patients were found to have an SSI with 7 (11.3%) patients having deep infections and 3 (4.8%) had superficial infection. Vertebral level operated, etiology, and diagnosis were not statistically significant for SSI. However, spinal instrumentation, surgery on cervical region and wound inspection on or before postoperative day 5 were associated with an increase in the rate of SSI. Comorbidities such as diabetes mellitus, obesity, and anemia were significant risk factors. The organisms cultured were Pseudomonas and Staphylococcus species. Conclusions: Wound infection is a significant complication of posterior spine surgery. This causes distress for both patient and surgeons alike. Uncontrolled diabetes, spine instrumentation and long duration of surgery are significant risk factors for SSI. Practices of early wound inspection, frequent wound dressing changes and not keeping to nontouch technique for changing and removing dressings are important risk factors for SSI in posterior spine surgeries that need to be changed to reduce the burden of SSI.

Kimura's disease (KD) is a rare chronic inflammatory disease of subcutaneous tissues and occurs predominantly in head and neck region. It is seen primarily in young Asian males. Typical clinical presentations are painless subcutaneous masses, regional lymph node enlargement, blood and tissue hypereosinophilia, and increased serum IgE levels. Here, we present a case of a 27-year-old female who presented with unilateral single nodular swelling in the right postauricular region. The diagnosis of KD was done based on characteristic histopathologic finding in conjunction with peripheral eosinophilia and increase in serum IgE levels.

In the last decades, an increased incidence of pulmonary embolism (PE) and acute dissection (AD) of aortic aneurysms has been registered mostly due to increased availability of advanced imaging techniques. They seldom occur concomitantly in the same patient. In this paper, we present the clinical challenges and controversies of diagnosis and therapy in a 70-year-old male patient with an atypical presentation of high-risk PE occurring concomitantly with a silent AD of a thoracic aortic aneurysm.

A case of Fitz-Hugh-Curtis syndrome in a 32-year-old para 1⁺¹ is reported. She presented with inability to conceive of 4 years duration. Her husband's semen analysis was within normal range. She had a hysterosalpingogram that showed bilateral tubal blockage and clinical assessment showed right sided abdominal tenderness, cervical excitation tenderness, and adnexa tenderness. The endocervical swab test for Chlamydia trachomatis was a positive. Laparoscopy and dye test showed adhesion bands on the under surface of the liver (the violin string appearance). She recovered well postoperatively. The couple received ofloxacin and metronidazole for 2 weeks. Literatures on Fitz-Hugh-Curtis syndrome presentation, pathogenesis, and management were reviewed.

Pyoderma gangrenosum (PG) is a rare, but serious neutrophilic dermatosis characterized by recurrent painful cutaneous ulcerations. It is commonly associated with inflammatory bowel disease, rheumatoid arthritis, and hematological malignancies. Because laboratory evaluations and histologic features of PG are nonspecific, diagnosis is based on the clinical features of the ulcer and requires exclusion of other conditions that cause such ulceration. The disease responds to glucocorticoids, immunosuppressives, and anti-inflammatory drugs. We present a 30-year-old man with acute myelogenous leukemia (subtype M5) and bullous PG. Treatment with high-dose prednisolone was successful.