Background and Aim: Platelet-rich fibrin (PRF) can be named as a natural fibrin-based biomaterial favorable to increasing vascularization and able to guide epithelial cell migration to its surface. The membrane has a significant positive effect on protecting open wounds and accelerating healing. Similar to PRF Ankaferd Blood Stopper (ABS) also has positive effects on wound healing. The aim of this study was to detect if we can improve known physical properties of PRF combining with ABS. This idea was based on the known mechanism of ABS in forming protein network without damaging any blood cells. Materials and Methods: A total of 25 adult rabbits used for collecting 5–7 ml of blood passively with the help of winged blood collection needle to the test tube. Collected samples were centrifuged at 3000 rpm for 10 min. Two similar samples obtained from each animal and one of the samples was placed in 20% ABS 80% saline solution for 5 min. Mechanical properties of the membrane samples were measured using Universal Testing Machine. Results: There is the statistically significant difference between PRF and ABS added PRF in elongation/mm (dL) and elongation/% at break values. Maximum force (fMax) and modulus values did not show any statistically significant differences. Conclusion: ABS loaded PRF causes better physical properties. This combination seems to exhibit superior performance when used as a membrane barrier solely. Advanced studies can be done on biological properties of ABS loaded PRF, especially on tissue healing.

Objectives: The objective of the study is to evaluate the effects of repeated bracket bonding on the color changes of tooth enamel after in vitro coloration. Materials and Methods: Eighty-one premolars were equally divided into three groups. Samples in Group 1 (G1) represented nonorthodontic treatment patients, and the enamel surfaces were left intact. Samples in Group 2 (G2) and Group 3 (G3) represented orthodontic treatment patients with no repeated bonding and brackets bonded 3 times, respectively. After the brackets were bonded in G2 and G3, samples in all groups were kept in four different staining solutions for 96 h and received 24 h of photoaging. This cycle was repeated 3 times. Brackets were debonded and rebonded in G3 samples after each cycle, whereas brackets were only debonded once in G2 samples after the third cycle. The color changes were assessed using a spectrophotometer at baseline (T1) and after removing the brackets and cleaning the enamel surface (T2). Data (ΔE) were analyzed statistically with analysis of variance between groups, and with Paired t-test within groups. Results: Although the color changes for G1, G2, and G3 were significant (P < 0.05) within groups; the difference was similar between groups (P > 0.05). Conclusion: Repeated bracket bonding does not have a negative influence on the enamel color change after in vitro coloration when compared with intact enamel surface and single bonding.

Aims: This aim of this study is to evaluate and to compare the clinical performances of two nanohybrid composite resin systems used for diastema closure and tooth reshaping at 4 years. Subjects and Methods: Twenty-three patients with midline or multidiastema problem were enrolled in this study. Nanohybrid resin composite systems to be used on each patient were randomly selected. Thirty seven teeth of 10 patients were restored with Filtek-Z550 (3M/ESPE) in combination with Adper™ Single Bond 2 (3M/ESPE) etch and rinse adhesive in Group 1 whereas 39 teeth of 13 patients were restored with Charisma-Diamond (Heraeus Kulzer) in combination with Gluma2 Bond (Heraeus Kulzer) etch and rinse adhesive in Group 2, by two operators. Esthetic, functional, and biological properties of the restorations were evaluated at baseline, 1, 2, 3, and 4 years using foreign direct investment criteria by two independent examiners. Statistical Analysis Used: The data were evaluated using Fisher's Chi-Square (P = 0.05). Results: Fifty-eight restorations (19 patients) with a mean service time of 43.4 months were evaluated (recall rate 82.6%). One Filtek-Z550 and two Charisma-Diamond restorations were repaired due to partial fracture (Score 4). Survival rates of Group 1 and Group 2 were 96.3% and 93.5%, respectively (Kaplan–Meier) (P > 0.05). Qualitative deteriorations were observed within each group according to baseline regarding surface luster, surface/marginal staining, marginal adaptation, patient's view, and periodontal response (P < 0.05). However, there were no significant differences between two restorative materials for any of the criteria assessed (P > 0.05). Conclusions: Both nanohybrid composite resin systems revealed esthetically, functionally, and biologically acceptable clinical performance when used for diastema closure and tooth reshaping at 4 years.

Purpose: This study aimed to evaluate the effect of a low-level laser therapy (LLLT) on pain, trismus, and swelling of patients whose impacted 3^rd molar tooth was extracted compared to placebo or “sham” treatment and measure volumetrically the edema with a three-dimensional (3D) surface imaging device (3dMD face system). Materials and Methods: Forty-five patients over 17 years of age were included in the study. Patients were randomized to three groups; Group 1, the control group, received only routine management (ice application) (n = 15); Group 2, received single-dose LLLT immediately after surgery (n = 15); and Group 3, placebo group, received sham therapy immediately after surgery (n = 15). In this study, a gallium-aluminum-arsenide diode laser device was used. The laser was applied extraorally (0.3 W, 40 s, 4 J/cm²). The trismus, pain, and facial swelling were evaluated. A 3D surface imaging device (3dMD Photogrammetric System) was used to evaluate the volumetric changes of the swelling. The 3D morphology of the facial swelling was recorded using this imaging device immediately before surgery, the second day after surgery, and the 7^th day after surgery. IBM SPSS statistics 22.0 program was used in the statistical assessment and P < 0.05 was considered statistically significant. Results: There was no statistically significant difference in the edema and trismus between the groups. The pain level in Group 2 was significantly lower than that in Group 3 at all-time points. Furthermore, the pain level in Group 2 was significantly lower than that in Group 1 on day 7. Conclusions: LLLT reduced the intensity of pain following third molar surgery by single dose. The results of this study revealed that LLLT reduced facial swelling, but no significant differences were found among the three groups. In addition, a 3D craniomaxillofacial imaging method provided insight into volume changes after 3^rd molar surgery and the evaluation of facial swelling in an objective way.

Background: The liberalization of abortion laws in Nigeria has been an interesting debate for a long time. Both proponents and opponents have defended their positions with similar vigor. However, the opinion of the Nigerian woman on the subject matter has received little attention. It is important to understand the opinion of the Nigerian woman, especially with regard to the potential impact of any abortion law on unsafe abortion. Objective: The objective of this study is to determine the impact of abortion laws on women's choice of abortion service providers and facilities in Southeastern Nigeria. Methods: Women attending the gynecological clinics of two tertiary hospitals in Southeastern Nigeria were interviewed with interviewer-administered questionnaires. Questions were asked on awareness of abortion laws, opinion on liberalization of abortion laws, and the impact of abortion laws on women's choice of abortion service providers in situations of unwanted pregnancies. Results: A total of 1120 women were interviewed. More than half (57.7%) of respondents were aware of the abortion laws of Nigeria. About 59.2% of respondents had previously done abortion for unwanted pregnancies. Some (78.3%) of respondents indicated that abortion laws will not influence their choices of abortion service providers in cases of unwanted pregnancies. Majority (78%) do not support liberalization of abortion laws. Conclusion: The abortion laws in Nigeria do not influence women's choice of abortion service providers and facilities. Factors other than the contents of abortion laws influence women's choices. The findings of this study open a new vista toward the search for the factors that drive unsafe abortion in Nigeria.

Background: Despite many attempts to improve the patency rate of biliary stents in patients with inoperable perihilar cholangiocarcinomas, the longevity of these stents has not been satisfactory. The purpose of the present study is to report technical outcomes and clinical efficacy of the placement of compound tri-metal stent in patients with malignant perihilar biliary obstruction. Materials and Methods: Retrospective analysis was performed of the medical records of 26 consecutive patients with inoperable malignant perihilar biliary obstruction who underwent compound tri-metal stent placement through a percutaneous transhepatic biliary drainage tube from January 2012 to April 2017. Results: Placement of the compound tri-metal stent was successfully completed in all 26 patients (technical success, 100%). There was neither procedure-related mortality nor 30-day mortality. None of these patients underwent additional metallic stent placement within 60 days secondary to recurrent cholangitis or stent occlusion. Successful drainage was achieved in 25 (96.2%) of 26 patients who received a compound tri-metal stent. Patients treated with compound tri-metal stent placement had a median stent patency of 145 days (range, 24–426 weeks) and a median survival time of 188 days (range, 37–1732 days). Conclusions: Placement of compound tri-metal stent in patients with malignant perihilar biliary obstruction may offer a safe and effective alternate technique to improve biliary drainage and stent patency.

Background: Mycoplasma hominis is often present in the amniotic cavity with microbial invasion associated with spontaneous preterm labor. Conventional culture method is the gold standard for detection of Mycoplasmas, but real-time polymerase chain reaction (real-time PCR) has revolutionized the diagnosis of M. hominis. Objective: The purpose of this study is the comparison of the culture methodology with real-time PCR for the detection of M. hominis in amniotic fluid samples. Methods: Amniotic fluid samples were collected from 65 pregnant women (age range: 25–45 years) previously followed at an infertility clinic. They were collected by transabdominal genetic amniocentesis during 16–21 weeks of gestation. Amniotic fluids were inoculated in SP4 broth for 48–72 h, and after becoming alkaline, culture suspension was spread on A7 agar plate for 1 week till the typical colonies seen in “fried-egg” morphology under stereomicroscope. DNA was extracted using a QIAGEN Mini DNA kit. The real-time-PCR was performed using Rotor-Gene Q Real-time PCR instrument. A melting-curve analysis was also performed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured by real-time PCR by taking culture as gold standard. Results: Sixty-five women in 16–21 weeks of gestation, with a mean age of 33 ± 5.06 years, were enrolled into this study. M. hominis detected by culture and real-time PCR assay was 72% (47/65) and 69% (45/65), respectively. 66% (43/65) specimens were positive by both methods. Real-time PCR sensitivity was 91.5%, specificity 88.9%, PPV 95.6%, and NPV 80%. Conclusion: Rapid detection of Mycoplasmas causing maternal complications such as neonatal infections and preterm labor in pregnancy by real-time PCR may be important and necessary. The high sensitivity and shorter time requirement of real-time PCR support its further development for diagnosis of Mycoplasma infections.

Objective: The objective of this study was to determine the ora-dental health and its relation with medication and dental fear in a group of Turkish children with attention-deficit hyperactivity disorder (ADHD). Subjects and Methods: The levels of dental fear of children were determined with The Dental Subscale of Children's Fear Survey Schedule (CFSS-DS). The oral and dental health evaluation was performed. This study included a total of 117 children aged between 6 and 15 years and they were examined under two groups as “ADHD” (n = 59) and “Control” (n = 58). Ora-dental health variables were compared between the groups and were also analyzed in accordance with dental fear and medication. Results: ADHD children and the control group exhibited similar CFSS-DS scores (15–32). No significant differences existed in df(t)/df(s), DMF(T)/DMF(S), d/D values, and presence of the white spot lesions. ADHD children's Mutans streptococci and Lactobacillus quantities were found significantly higher than the control group. The incidence of parafunctional habits of the ADHD children was also found high. Conclusions: ADHD children that were medicated exhibited similar dental caries prevalence and periodontal health status. Although ADHD group had similar dental-periodontal health status and dental fear level with the control group and using ADHD medicines did not make a significant effect on the ora-dental health parameters, the patients should be carefully followed up because they were categorized in high caries risk groups.

Objectives: Significantly low serum levels of complement components have been reported in patients with Sickle cell anaemia (SCA) which may result in a high susceptibility to infections. However some studies have reported a normal or high complement level. The aim of our study was to assess some haematological parameters and Complement levels in adult patients with steady state SCA in Zaria, North western Nigeria. This will serve as a guide towards infection surveillance in the quest to reduce significant morbidity and mortality in our setting. Methods: A cross sectional study of 40 patients with SCA in steady state and 40 healthy (non-matched) non-SCA controls at the Haematology clinic of Ahmadu Bello University Teaching Hospital Zaria, was carried out over a 6 month period in 2016. Institutional ethical approval and informed written consentwere obtained. Venous blood was analyzed for haematological parameters by an automated method and complement levels; alternative pathway was assessed by measuring C3, classical pathway by C4 and Terminal pathways by C5 levels using ELISA technique. Data was analyzed with statistical package for social science(SPSS) software version 20.0(2001) and a p value of ≤ 0.05 was considered significant. Results: The age range of patients with SCA and controls were 18 to 46years and 18 to 48years respectively and these were not significantly different p > 0.05. The median levels of C3 (245μg/ml), C4 (245μg/ml) and C5 (40μg/ml) were within normal range in the study subjects but significantly higher (p < 0.05), than those of the controls C3 (165μg/ml), C4 (125μg/ml) and C5(35μg/ml). Haematological parameters showed no correlation with the levels of Complement components studied. Conclusion: Although Complement components C3, C4, and C5 levels in patients with SCA are significantly high, the infectious susceptibility may be due to other immunological abnormalities.

Purpose: The aim of the present investigation was to evaluate the effect of autoclave polymerization method on the mechanical and dynamic mechanical properties of different polymethylmethacrylate denture base materials. Materials and Methods: Three different denture materials were used during the study, two of them were heat polymerizable denture base material (Meliodent and Paladent) and one was microwave polymerizable denture base material (Acron MC). Duncan test was used for the statistical analysis. Statistical analyses were completed using a two-way analysis of variance. Statistical analysis of test results was carried out with a 95% confidence level. Results: Tensile strength was increased with autoclave polymerization regardless of the denture base material type. Paladent specimens with autoclave polymerization (30 min at 60°C and 10 min at 130°C) have the highest average impact strength value. Acron MC specimens have the highest average flexural strength and modulus. Flexural strength improved with autoclave polymerization for both of 10 and 20 min polymerizations for each of Meliodent and Paladent specimens. Conclusions: Autoclave polymerization provided higher polymerization temperatures compared with the conventional heat polymerization. Autoclave-polymerized acrylic resin specimens showed higher tensile strength values; however, this was not the case for the impact test results. Flexural strength of specimens was improved with autoclave polymerization. Glass transition temperature was increased with autoclave polymerization.

Objective: The purpose of this study was to investigate the clinical effects of erbium, chromium: yttrium, scandium, gallium, garnet (Er, Cr: YSGG) laser treatment as a complementary to scaling and root planning (SRP) during the treatment of chronic periodontitis and gingival crevicular fluid (GCF) interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and interleukin-35 (IL-35) levels. Materials and Methods: Forty patients with chronic periodontitis were divided into two equal groups at random to receive SRP alone and SRP followed by Er, Cr: YSGG laser treatment, which are control and test groups, respectively. Clinical attachment level (CAL), probing depth (PD), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were measured for all patients in both groups at baseline and again at the end of the 1^st, 3^rd, and 6^th months following the treatment. Levels of GCF IL-1β, IL-6, and IL-35 were analyzed by enzyme-linked immunosorbent assay. Results: After periodontal treatment, CAL, PD, BOP, GI, and PI, which are clinical parameters analyzed, decreased significantly (P < 0.05) in both test and control groups. GCF volume, IL-1 β, IL-6, and IL-35, levels in both groups proved statistically significant reductions compared to the baseline (P < 0.05), but no substantial variations were detected among both groups. Conclusion: According to these results, we can suggest that IL-35 may be related to the pathogenesis of periodontitis and that Er, Cr: YSGG laser can be used as an adjunct to SRP in periodontal treatment.

Objective: To assess the oral health-related quality of life (OHRQoL) of preschool children with cleft lip and palate (CLP) and their relatives. Materials and Methods: In this cross-sectional study, 55 2–5-year-old children with the history of CLP were randomly selected from those referred to Shiraz Lip and Palate Cleft Research Center and treated with single-stage closure (Push back palatoplasty). Furthermore, same number of children with the same age who attended the Shiraz School of Dentistry for routine dental care were selected as control group using randomized sampling. Children's demographic data were obtained from their parents. Farsi version of the Early Childhood Oral Health Impact Scale (F-ECOHIS) was used for evaluating these children's QoL. Results: We found a significant difference in OHRQoL between children with CLP and children without CLP in the overall score of F-ECOHIS and all of subscales. In the impact on children subscale, the difference between these groups was remarkable in limitations' domain. As for difficulties faced by children, question on “difficulty in pronouncing words” had the highest average score. Furthermore, in impact on family, in parental distress domain, the difference between these groups was remarkable. For difficulties faced by family, financial impact got the highest average score. No significant difference was found between boys and girls with CLP in all subscales. While according to the score of total F-ECOHIS in unilateral and bilateral CLP children, there was statistically significant difference in these groups. Conclusion: Since oral clefts affect the QoL of children and their families even after the usual treatments, the implementation and maintenance of multidisciplinary interventional strategies are required for establishment of facial esthetics, oral function, and psychological support for such individuals.

Objective: This study compared the esthetic outcomes of 1-year follow-up of immediate and late implant loading after implant restoration of a single tooth in the anterior maxilla. Materials and Methods: A total of 33 patients with missing teeth in the anterior maxilla (Central = 8/lateral = 22/canine = 3) were enrolled in this study (18 immediate loading and 15 late loading). At after cementation, 1, 3, 6, and 12 months photographs were taken of anterior maxilla. The photographs were assessed using pink esthetic score (PES) which consists of seven variables. All PES data were analyzed with independent sample t-tests and repeated measures ANOVAs. Results: PES values increased significantly in both groups at the 1-year follow-up (P > 0.05). There was no statistically significant difference between the immediate and late loading groups at any time point (P > 0.05). Conclusions: Within the limitation of this study, immediate loading did not have a negative effect on esthetics.

Background: Acetabular reconstruction following bone loss is a major challenge facing the arthroplasty surgeon. Traditionally, the armamentarium for the treatment of large bone defects (Paprosky Type 2C or 3) included antiprotrusio cages (APC). The aim of this study is to determine the pattern of presentation and assess the early functional outcome of patients who had undergone acetabular reconstruction using APC in complex primary total hip replacement (THR). Patients and Method: Between November 2008 and November 2015, 38 THR were carried out in 35 patients who required acetabular reconstruction, at Davidson and Judith Consultants Clinics Enugu, Nigeria. Results: There were 25 males and 10 females, with a ratio of 2.5:1. The average age of the patients was 61.33 ± 6.92 with a range of 56 to 72. The mean pre-op Harris score was 49.02 ± 2.3.The mean post-op Harris hip score (HSS) was 88.75 ± 10 (P < 0.001) at one year and 92.25 ± 13 (P < 0.001) at 5 years. The etiology showed that most (52.63%) of our patients had primary osteoarthritis with Type 3 acetabular defect. Two (5.26%) patients had the following complications: dislocation (2.63%) and screw breakage (2.63%). The minimum follow-up period was 5 years. Discussion: After follow-up at 1 year and 5 years, the hips showed significant improvement concerning pain, gait, and mobility based on HHS and were able to return to their various professions. Conclusion: APC provides a satisfactory solution for patients who present with acetabular deficiency in complex primary THR.

Purpose: The aim of this study was to evaluate the effects of the different sized alumina particles (50 and 150 μm) and tribochemical silica-modified alumina particles (110 μm) on titanium (Ti) surface to identify the most effective method of increasing the bond strength between porcelain and Ti. Materials and Methods: Thirty rectangular plates (15 mm × 50 mm × 1 mm) of commercially pure Ti (Cp Ti) Grade 5 (GC Dental Industrial Corporation, Tokyo, Japan) were divided into three groups for different surface modification procedures (n = 10). Ti bonder porcelain, opaque, and dentin layers were fired separately on Ti plates. All specimens were placed in a bending jig for four-point bending test. The load and crosshead displacement data were collected to calculate the strain energy release rate as a G value. Results: Lowest mean G values in J/m² were in the group sandblasted with 150 μm Al₂O₃particles (Group 2) (18.6 ± 5), followed by the group sandblasted with 50 μm Al₂O₃particles (Group 3) (20.8 ± 6.1) and the group sandblasted with 110 μm silicoated Al₂O₃particles (Group 1) (24.5 ± 4.1). The one-way ANOVA and Bonferroni post hoc tests indicated that there was a statistically significant difference between Group 1 and Group 2 (P < 0.05). There were also no statistically significant differences between Group 1 and Group 3 and Group 2 and Group 3 (P > 0.05). Conclusion: The size of alumina particles is not a factor that is directly effective in enhancing the bond strength of Ti–porcelain systems. The bond strength of Ti–porcelain systems can be extremely improved by the application of sandblasting with silica-coated alumina particles.

Background: When examining the incidence of autism, however, children should not be considered independent of their parents, as this collection of disorders also affects the life of their family members. Having a disabled child affects the relationships with the family and friends, and the social and work life of families. The quality of life of these families is discussed in terms of financial aspects, health, support of family members, values, occupation, family relations, and individual support dimensions of developmental disabilities. However, there are very limited studies on the relationship between perceived social support and quality of life of parents of children with autism, and none of these has been conducted in Turkey. Aim: This study aimed to identify the perceived social support and quality of life of the parents of children with autism and to investigate the related factors. Study Design: The sample of the study consists of 90 parents who accepted to join the research studies. The participants enrolled in the study included 90 biological parents (31 mothers; 59 fathers). Eighteen children had both mother and father participate (all participants subsequently will be referred to as “parents”). Methods: This was a descriptive cross-sectional study. A socio-demographic form, the EUROHIS Quality of Life Scale (EUROHIS QOL-8) and the Multi-Dimensional Scale of Perceived Social Support (MSPSS) were used for data collection. Results: The mean score on the EUROHIS QOL-8 was 26.17 ± 4.91 and that on the MSPSS was 51.06 ± 20.6. A statistically significant relationship was found between the EUROHIS QOL-8 and MSPSS scores (r = 0.524, P = 0.000). There were significant differences on the average score on the EUROHIS QOL-8 and MSPSS based on fathers' job status. Conclusion: Our results provide important insights into the family experiences of parents of children with autism, and may aid the development of appropriate interventions to further support them. Providing support and understanding families of children with autism and their experiences, nurses, doctors and health professionals can positively affect their health outcomes. Healthcare professionals should focus on determining the needs of families to accordingly plan and implement appropriate programs.

Introduction: In patients with established coronary artery disease (CAD), there are different reports on gender, age, dyslipidemia, and obesity according to smoking behavior. Smoking, obesity, and dyslipidemia are targets in secondary prevention. In this study, we aimed to investigate the sociodemographic differences, lipid profiles, body mass index (BMI), and cigarette smoking status in patients diagnosed with CAD. Methods: Patients with records of angiography, smoking behavior, sociodemographic information, lipid levels, and BMI present at the outpatient visits were included in the study. Patients were grouped as active smokers, nonsmokers, and former smokers. Statistical methods were used for comparison of variables and means. Results: A total of 235 patients, 167 (71.1%) men and 68 (28.9%) women, were included in the study. Nonsmokers group (31.4%) consisted of mostly women while active (22.6%) and former smoker (46%) groups consisted mostly of men (P < 0.0001). The mean age was 60.65 ± 11.55. Age was associated with the smoking status of patients, and nonsmokers consisted of geriatric patients significantly (P = 0.001). Educational status was associated with smoking history. Cessation of smoking after CAD diagnosis was achieved in 46% of patients. Active smokers had highest mean triglyceride (TG) values while nonsmokers had highest mean high-density lipoprotein-cholesterol (HDL-C) values. Active smokers had the highest mean TG values while nonsmokers had the highest mean HDL-C values. BMI was higher in nonsmokers than active smokers. Conclusion: Gender, age, and educational status are determinants of smoking behavior in patients with CAD. BMI is associated with smoking history. In nonsmokers, values of HDL were highest while TG values were lowest. To prevent reoccurring cardiovascular events, young patients and men are two groups which health professionals need to concentrate in motivating to quit smoking.

Context: Snodgrass method (tubularized incised plate urethroplasty [TIPU]) is a widely used technique for hypospadias repair. Aim: It was aimed to compare the outcome of hypospadias repair with stenting using feeding tube compare with those with Foley catheter. Subjects and Methods: The demographic characteristics of the 123 patients who underwent hypospadias repair with Snodgrass method, the success of the applied method, and the factors affecting fistula complication were evaluated retrospectively. Patients were divided into two groups: those operated before January 2010 (Group A) and those who were operated after (Group B). In Group A patients, urethroplasty was performed using silicone Foley catheters, in which balloon of these catheters was filled by saline at appropriate size. In Group B, urethroplasty was performed using feeding catheter. Results: Group A and Group B consisted of 32 and 91 patients, respectively. Fistula developed in 10 (31.3%) and 4 (4.39%) patients in Group A and Group B, respectively. There was a statistically significant difference between the two groups in terms of the development of fistula complication (P = 0.0002). Conclusion: The use of a feeding catheter in TIPU could be a more advantageous than using a Foley catheter.

Background: Although there are many methods of treatment for knee osteoarthritis (OA), total knee replacement (TKR) is a very effective way of managing this condition as it improves function and alleviates pain with a consequential improvement on quality of life of patients. To our knowledge, no comprehensive study of the outcome of TKR has been published in our environment, hence the need for a study of our TKR outcomes. Objectives: The aim of this study is to describe the pattern of presentations of our patients with knee OA who have undergone TKR, assess the outcome, and identify any variables that affect the outcome. Patients and Method: Between November 2008 and November 2013, 68 TKRs for treatment of end stage arthritis were carried out for 52 patients. All the patients were implanted with the same prosthesis design (DePuy and Biomet) and had posterior cruciate substituting knee. The average follow-up was 5 years. The preoperative and postoperative Oxford knee score (OKS) was used for outcome measurement at 1 and 5 years. Results: There were 20 males and 32 females (M:F ratio = 5:8). The mean age of the patients was 63.54 ± 0.62 with a range of 55 to 77. There were 18 (26.47%) valgus knees with a mean angle 22.07° ± 5.73°, 12 (17.65%) varus knees with a mean angle 14.69° ± 2.84°, 8 (11.77%) knees with flexion deformity with a mean angle of 10.2° ± 1.32°, and 30 (44.11%) knees had no deformities at all. The variables like deformities, comorbidities, gender, side-affect, and occupation did not affect the outcome (P > 0.05). At 1 year and 5 years, there was no radiological evidence of osteolysis, loosening, or component subsidence. Conclusion: Despite the deformities and comorbidities, our patients presented with quality of life improved based on the improved OKS of the patient. We recommend a well-planned meticulously executed TKR for patients with debilitating OA in our environment.

Introduction: Sleeve gastrectomy represents one of the most common surgical procedures used in bariatric surgery. The most feared complication following laparoscopic sleeve gastrectomy (LSG) is the leak that occurs at the staple line. One method to reduce the risk of leak is the use of reinforcement material at the suture line. In this study, the efficacy of sutures and fibrin glue in the prevention of staple leak has been compared retrospectively. Methods: A total of 250 patients undergoing LSG between October 2011 and August 2015 at the Medical Faculty of Firat University were retrospectively assessed using the hospital database system records. Results: There were 77 males (31%) and 173 (69%) females, with a mean age of 34 years (range: 16–65 years) and mean body mass index of 45 kg/m². Staple line was sutured in 54 patients (22%). Neither suture nor fibrin glue was used for reinforcement of the staple line in 61 (24%) patients. Only fibrin glue was used for the reinforcement of the staple line in 135 (54%) patients. Postoperative leak occurred in eight patients (3.2%). Neither suture nor fibrin glue was used for reinforcement in 6 (9.8%) of these patients. One of them was in sutured staple line group and the other was in fibrin glue group (0.7%). One patient died due to leak and the consequent development of sepsis (0.4%). Conclusion: Despite some controversies, strong evidence exists on the effectiveness of fibrin glue in the prevention of leaks in patients undergoing LSG from this study.

Introduction: This study investigated the dental health problems and saliva characteristics of children under psychostimulant therapy for attention-deficit hyperactivity disorder (ADHD). Materials and Methods: One hundred and twenty children aged 7–12 years were divided into three groups. Groups 1–2 comprised children diagnosed with ADHD: those who had not yet started psychostimulant therapy (Group 1) and those already receiving long-term psychostimulant therapy (Group 2). Group 3 comprised healthy, nonmedicated children. Possible side effects of psychostimulants were investigated at the beginning of study in Group 2 and after 3 months drug use in Group 1. Bruxism and dental erosion prevalence, salivary Streptococcus mutans count, buffering capacity, and stimulated salivary flow rate (SSFR) were measured, and salivary α-amylase, calcium, total protein, and proline-rich acidic protein (PRAP) levels were quantified in the beginning of the study. Data were analyzed using the Kruskal–Wallis test. Results: The most frequently reported side effects of psychostimulants were decreased appetite, dry mouth, and increased fluid consumption. The prevalence of bruxism and dental erosion was higher in Groups 1 and 2 than in Group 3, but the differences were not significant (P > 0.05). In Group 2, subjective dry mouth feel was reported by 32.5% of patients and 17.5% had a very low SSFR. Salivary α-amylase, calcium, total protein, and PRAP levels were lower in Group 2 than the others, but the differences were not significant (P > 0.05). Conclusions: ADHD and psychostimulant therapy do not appear to be significantly related to decreasing SSFR or protective saliva components against dental caries. However, a systematic investigation of the long-term safety of psychostimulants is needed. The most effective method of maintaining dental health of children with ADHD is frequent appointments focusing on oral hygiene practices accompanied by dietary analyses.

Background: This research examined multimodal analgesia and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for early analgesic effect and rehabilitation after total knee arthroplasty (TKA). Methods: A total of 110 patients who were scheduled to undergo TKA were randomly divided into two groups, experimental group and control group. The experimental group received a periarticular multimodal drug injection containing 200 mg ropivacaine, 30 mg ketorolac tromethamine, 0.3 mg epinephrine, and 5 mg hexadecadrol during surgery. The control group received an equal volume of normal saline. All the patients received an analgesia pump and moderate NSAIDs. Resting and motion numeric rating scale (NRS) scores, knee joint range of motion, length of postoperative hospital stay, patient satisfaction, total nonsteroidal anti-inflammatory consumption, and side effects were recorded. Results: The experimental group exhibited significant improvement in pain NRS scores during rest and exercise several days postoperatively. The range of joint motion was more flexible in the experimental group, and the length of postoperative hospital stay was shorter (9.25 ± 1.99 days vs. 10.44 ± 2.62 days, P < 0.05). Patients in the experimental group consumed fewer NSAIDs (965 mg vs. 1325 mg, P < 0.05) and reported greater satisfaction with the surgery. Conclusion: Intraoperative periarticular injection with multimodal drugs significantly relieved pain after surgery and reduced the requirements for NSAIDs. This injection also improved patient satisfaction and the range of joint motion with no apparent risks following TKA.

Chronic rhino-sinusitis (CRS) is a significant health problem whose incidence and prevalence is rising. An emphasis has been placed on diseasespecific quality of life (QoL as the predominant measure for most current outcome studies. Therefore a validated measure of health-related QoL in sinonasal disease is needed. The present prospective and observational study was conducted on 50 patients in the Department of ENT at Govt. Medical College and Rajindra Hospital Patiala, Punjab, India. The primary outcomes were the following: (1) the chance of attaining minimal clinically important difference (MCID) improvements of nine points at the 22-item Sino-Nasal Outcome Test (SNOT-22) after endoscopic sinus surgery (ESS) for different preoperative QoL levels, and (2) the percentage of relative improvement in SNOT-22 after ESS for different preoperative QoL levels. Methods: Patients with CRS who were elected for ESS were prospectively enrolled into an observational cohort study. They were categorized into 10 preoperative SNOT-22 groups based on 10-point increments beginning with a score of 10 and ending at 110. Standard protocol for all patients presenting for evaluation included completion of the SNOT-22 prior to and following surgical intervention. The scores were calculated and the data collected were compiled and analyzed. Results: A total of 50 patients were included in this study. Patients with a SNOT-22 score between 10 and 19 had the lowest chance of achieving an MCID. Patients with a SNOT-22 score greater than 30 had a greater than 90% chance of achieving an MCID, and there was a relative improvement of 43.3% on their preoperative SNOT-22 scores. CRS patients with polyp had better outcomes (47.1% improvement) after ESS than those without polyp (33.2% improvement). Conclusion: There is an increased probability of achieving an MCID at SNOT-22 score >30 and in general the percentage of relative improvement increased with an increase in preoperative SNOT score.

Solid pseudopapillary neoplasm of pancreas (SPN) during pregnancy is rare and presents a threat both to the mother and the fetus. We report a case of SPN in a 26-year-old woman diagnosed at 21 weeks of gestation. Tumor enucleation was successfully performed by a general surgeon. A healthy female infant was delivered at 39 weeks and 5 days of gestation vaginally without complications. Our report provides an example that tumor enucleation of SPN during the second trimester could be successfully performed during pregnancy. A multidisciplinary approach with respect to the pregnant patient's diagnosis, indications, and timing of surgery is necessary in ensuring the best possible outcomes for both the mother and the child.

Pemphigus vegetans (PVeg) is a relatively milder and chronic variant of pemphigus vulgaris. It is very rare, constituting only about 3% of all cases of pemphigus. It is characterized by initial bullae or pustules which may then progress to papillomatous vegetations or plaques. Usually, oral mucosal and cutaneous lesions are seen in the same patient. Very rarely, only mucosal presentation may be seen. In this report, we present a case of a 30-year-old woman with previously undiagnosed multiple, painful, chronic vegetative ulcers with “snail-track”-like appearance present for 3 years. Extensive clinical and laboratory investigations revealed the lesions to be due to PVeg. The patient responded to prednisolone and cyclophosphamide therapy with complete remission after 2 months.