Background: Postoperative bronchopleural fistula (BPF) remains a serious complication due to its high morbidity and mortality. Although various endoscopic techniques have been defined for the closure of BPF previously, no standard algorithm yet exists. Aims: To study the effectiveness and safety of various endoscopic procedures in an interventional pulmonology unit. Materials and Methods: The medical data of 15 postoperative BPF patients, who were undergone endoscopic intervention were retrospectively investigated. Results: The mean size of the fistulas determined by bronchoscopic evaluation was 7.93 ± 3.26 mm (range 3-15 mm). Applied procedures were as follows: stent implantation (n: 8, 53.3%), stent implantation and polidocanol application (n: 4, 26.7%), only Argon Plasma Coagulation (APC) application (n: 2,13.3%), polidocanol application (n: 1,6.7%). Complete fistula closure was achieved in three of the 15 patients (20%). The procedures were partly successful in five (33.3%) patients and failed to be successful in seven (46.6%) patients. Survival rates in regard to procedural success were determined and a statistically significant difference was found in five-year survival rates (P = 0.027, P < 0.05). Conclusion: Our results demonstrated that bronchoscopic procedures can be safely and effectively performed in patients who were not eligible for surgery for various reasons.

Background: Many changes occur in human physiology with aging, and as expected complaints of geriatric patients differ from the other age groups in population. Aims: The objective of the study was to investigate the common complaints of geriatric patients attending to an otolaryngology clinic (ENT clinic), and to compare their complaints with the 18–65 years aged patients'. Materials and Methods: A total number of 41888 adult patients who visited the ENT clinic from 2015 to 2018 were retrospectively investigated. Patient complaints were scanned, and subcategorized as five groups (otologic/rhinologic/head and neck/ others/ neoplasias) and all data were evaluated. Results: Forty-one thousand, eight hundred and eighty-eight patients were included in the study, and 3946 of them were geriatric patients. The most frequent problem was otologic problems, followed by rhinologic problems among geriatric patients. However, rhinologic problems were the major complaint among the 18–65-year-old patients. A comparison of all the individual complaints bringing the geriatric patients to the ENT clinic revealed the three most frequent complaints: 1. hearing loss, 2. balance disorders, and 3. common cold. However, the three major complaints beyond nongeriatric adults were 1. tonsillopharyngeal disease, 2. common cold, and 3. inflammatory and infectious diseases of the sinuses, and these differences were statistically significant (P = 0.001*). Conclusion: It was found in this study that the five most frequently reported complaints of geriatric patients when applying to an ENT clinic are hearing loss, loss of balance, common cold, cerumen, and tonsillopharyngeal diseases. Unlike from nongeriatric population, otologic problems (most commonly hearing loss) were the essential ENT clinic complaints of geriatric patients.

Background: How the meniscus adapts to the morphological changes in the lateral tibiofemoral compartment, in terms of gene expression, was the reason to establish this present study. Objective: This study aimed to determine the changes in the mRNA levels of the apoptotic and autophagic genes in the discoid meniscus. Subjects and Methods: We have investigated the apoptotic and autophagic gene levels in discoid and normal lateral menisci of 21 patients (11 discoid and 10 control). The RNAs were isolated from the fresh discoid and healthy meniscal tissue. Gene expression was defined based on the threshold cycle (Ct), and Actin beta was used as a reference gene that acts as an internal reference to normalize RNA expression, which was calculated as 2−ΔΔCT. Results: Apoptotic and autophagic gene levels were significantly higher in the discoid meniscus group. In discoid meniscus samples, the Bcl-2 mRNA, BclXL, BAK mRNA, ATG 12, ATG 7, ATG 5, ATG 3, and Beclin1 mRNA levels were higher by 4.2, 5.9, 9.1, 8.3, 23.2, 6.1, 12.4, and 18.1 times, respectively, with statistically significant differences (p < 0.001). Conclusion: The discoid meniscus etiology should be considered both in morphological and genetic modulation manners: apoptotic and autophagic genes play roles with tibiofemoral morphological differences.

Objectives: We aimed to evaluate the efficacy of continuous local anesthetic infusion to the incision site with the On-Q elastomeric pump system in postoperative acute pain control after thoracotomy. Methods: A retrospective comparative analysis of of sixty patients who underwent thoracotomy for lung cancer by the same surgical team was performed between January 2016 and December 2017. The patients were divided into two groups according to postoperative pain management, those who were traditionally received tramadolol (15 mg/h) by intravenous continuous infusion (Group IVT, n = 30) and those who were administered continuous local anesthetic (0.5% bupivacaine, 4 ml/h) infusion to the incision site through an elastomeric pump in addition to the traditional treatment (Group LA, n = 30). The primary outcomes were postoperative acute pain scores on the numeric rating scale and postoperative rescue opioid consumption for 72 hours following surgery reported as pethidine equivalents. The secondary outcomes were frequency of analgesia related adverse events/complications, ICU and hospital stay, drug and total hospital cost. Results: The mean pain scores at 2, 12, 24, 48 and 72^th hours at rest and during coughing were found to be significantly lower in group LA (p < 0.05). Rescue opioid consumption on postoperative 0, 1, 2 and 3^rd days and in total was found to be significantly lower in Group LA (p < 0.05). In Group LA, postoperative length of hospital stay was significantly shorter (5.8 ± 2.1 days vs. 8.0 ± 3.1 days; p = 0.034), drug costs (95.24 vs. 160.08 Euro; p = 0.023) and total hospital costs were lower (434.26 vs. 685.75 Euro; p = 0.014) than Group IVT. Conclusions: We believe that continuous local anesthetic infusion to the incision site in addition to systemic analgesic treatment for multimodal acute pain management after thoracotomy is an effective and safe method.

Aim: To investigate the effect of platform switched short dental implants and subcrestal placement on von Mises stress in the maxillary anterior region (D3 bone) by using three-dimensional finite element model analyses (3D FEM). Materials and Methods: Biomechanical behaviour of von Mises stress in maxillary anterior region (D3) bone were stimulated with the help of 3D FEM with the help of ANSYS WORKBENCH version 17.5. The bone model had a cortical core of (1 mm) surrounding the inner cancellous core, which represents D3 bone. Two models were designed model 1 (6 x 4.6 mm), (7.5 x 4.6 mm) and model 2 (6 x 5.8 mm), (7.5 x 5.8 mm). Loads of 100, 200 N were applied at an angle of 0°, 15°, 30° along the long axis of the tooth model. Results: In all model's cortical bone exhibited greater stress than cancellous bone. Greater stress was reported in axial direction at 30° then 15° and least at 0° irrespective of load applied. An increase in implant length (7.5 mm) did not exhibit any stress reduction in both the model but implant diameter (5.8 mm) led to reduction in von Mises stress in both the groups. Greater the force applied greater was stress in both bones irrespective of direction of force applied (200N). Lastly subcrestal (0.5 mm) placement has slight reduction in stress compared to equicrestal placement in both the groups. Conclusion: Numerical results from the current study suggest that, for short implants, implant diameter is considered more effective design parameter than implant length. Current findings state that platform switch short subcrestal implants results in conservation of marginal bone loss along with better stress distribution around peri-implant regions in D3 bone. However, all models analyzed in this study showed development of von Mesies stresses within physiological limits for human cortical bone.

Objective: We aimed to study the factors affecting the mortality of trauma patients who underwent whole-body computerized tomography (CT) on Emergency department (ED) time frames in a developing emergency care system. Materials and Methods: This is a retrospective analysis of adult patients who received WBCT from August to November for two consecutive years (2014 and 2015). Non-parametric statistical methods were used to compare the patients who died and survived. The Backward logistic regression model was used to define factors significantly affecting mortality. Results: During 2014, 200 patients out of 827 (24.1%) received WBCT. During 2015, 263 patients out of 951 (27.6%) received WBCT. Four hundred sixteen patients were entered into the analysis. The overall mortality was 3.4% (7% in 2014 and 1% in 2015, P = 0.002). Significant factors found in backward logistic regression model defining factors affecting mortality were ISS (p < 0.0001), Glasgow Coma Scale (GCS) (p = 0.001). CT location (outside the ED in 2014, inside the ED in 2015) showed a very strong trend for affecting mortality (p = 0.054). Patients who had WBCT in the ED had lower ISS (p < 0.0001). CT imaging in the ED decreased ED to CT time 15.5 minutes (p < 0.0001), but admission time was 75.5 minutes longer. Conclusions: ISS and GCS were the main factors predicting mortality in patients who received WBCT. Patients received more WBCT imaging and physicians showed a tendency to order WBCT for less severe patients when the CT located in the ED. CT location did not show a significant effect on mortality, but on some operational time frames.

Background: The clinical diagnosis of chronic kidney disease (CKD) is based on estimated glomerular filtration rate (GFR) using serum creatinine-based equations. Many formulas are used in estimating GFR. Objectives: We set out to determine the degree of agreement between the Cockcroft-Gault (CG), 4-variable Modification of diet in renal disease (MDRD). Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in our indigenous population. Patients and Methods: Adult participants were recruited across all sectors of life, education, and occupation. Blood pressure, fasting blood glucose, lipid profile, urinalysis, serum creatinine, and anthropometry were measured. Estimated GFR (eGFR) was computed using CG, MDRD, and CKD-EPI equations with and without the race factor. The Lin's concordance index (rho_c) and Bland–Altman analysis were used to determine the degree of agreement between various pairs of creatinine-based eGFR equations [MDRD with the race factor (MDRD_w)]; MDRD without the race factor (MDRD); CKD-EPI with race factor (CKD-EPI_w); CKD-EPI without the race factor (CKD-EPI), and the CG equation. Results: Two hundred and sixty-one adults, mean age 47.5 ± 9.9 years, 45.2% females participated in the study. Hypertension prevalence in the study population was 41.4 (95% CI 35.3–47.6%) while diabetes mellitus was 8.1% (95% CI 5.0–12.0%). The proportion of individuals with eGFR_CKD-EPI less than 60 ml/min/1.73 m² was 17.6 (95% CI 13.2–22.8%). All pairs of rho_c were lower than the threshold of 0.9 except for eGFR_CKD-EPI versus eGFR_CKD-EPw. Conclusion: There is significant discordance in the eGFR obtained from the various serum creatinine-based GFR equations in our population suggesting the need to validate these equations and determine the best equation for our general population.

Background: Sepsis is a significant contributor of mortality all over the world. Emergency departments have a critical role for diagnosing a suspected sepsis in a patient, since early and proper administration of antibiotics may decrease mortality significantly. But, the unavailability of an objective and reliable diagnostic test is the major challenge of this critical issue. Aims: The aim of this study is to evaluate the prognostic value of a novel biomarker, the ischemia-modified albumin (IMA) in patients with sepsis and septic shock in emergency department. Subjects and Methods: This prospective, observational study included 81 patients with sepsis or septic shock and 75 controls. Sociodemographic characteristics of the patients, site of infection, IMA levels, other biomarkers (procalcitonin, pH, lactate), mortality at 24-h and 28-day were evaluated. Results: The serum IMA levels in patient and control groups were 117.8 ± 85 IU/g and 115.8 ± 134.0 IU/g, respectively (P = 0.072). There was a weak but statistically significant positive correlation between IMA and lactate levels (P = 0.009). The mortality rates of patient group at 24-h and 28 days were 21% and 79%, respectively, but serum IMA levels were not found to be a prognostic marker to predict mortality. Conclusion: The main reason for the similarity between groups regarding IMA levels was thought to be associated with the distribution of the acute and chronic health problems other than sepsis in the control group. Emergency department physicians should not only depend on serum IMA levels for predicting the prognosis of patients with sepsis or septic shock.

Background: Helicobacter pylori (H. pylori) is a common bacteria all over the world. The factors influencing the acquisition and prevalence of H. pylori infection are still poorly understood. Aims: The aim of this study was to determine the factors that may affect H. pylori positivity in patients who presented to the pediatric clinic. Subjects and Methods: The study included 374 children who attended the pediatric clinic with gastrointestinal complaints. The demographic characteristics of patients were recorded, and fecal samples were examined for H. pylori positivity with a prepared kit procedure. In addition, the samples were examined under microscope for the diagnosis of parasites in stool. The Chi-square analysis and binary logistic regression analysis were used for data analysis. The odds ratio was calculated as an estimate of the relative risk. Results: The study found the incidence of H. pylori positivity to be 18.7%. It was observed that in all H. pylori positive patients had growth retardation. H. pylori positivity had no significant relationship with the presence of parasites in the stool (p = 0.113). The results of the Chi-square test showed that H. pylori positivity was significantly changed age groups and educational levels. Logistic regression analysis showed that “age” and “educational status” are significant predictors of H. pylori positivity (p = 0.023 and 0.017, respectively). The risk of H. pylori positivity in the 11–18 age group patients was found about two times (OR: 2.024) higher than in the 6–10 age group patients. The risk of H. pylori positivity in those with education level of “Middle school and above” were found to be twice as high (OR: 2.126) than those with a primary education level (OR: 2.126). Conclusion: In this study, adolescent age and middle school and above level were found to be risk factors for H. pylori. This suggests that there may be other conditions influencing H. pylori positivity. Also, since the frequency of H. pylori is high in those with growth retardation, H. pylori should be considered when evaluating children with growth retardation.

Objectives: This cross-sectional observational retrospective study aimed at assessing the cephalometric skeleto-dental features of class I, II, and III skeletal relationships of Saudi female school children samples and comparing the results to the established North American Caucasian cephalometric standards. Methods: The sample consisted of 205 retrospective lateral cephalometric radiographs of female school children. The age range of the subjects was between 10 and 13 years with a mean age of 11 ± 1 years. Several cephalometric and constructed points were identified. Angular, linear, and proportional measurements were obtained and analyzed. The skeleto-dental features of class II and class III were compared to class I of this sample then compared with the established North American Caucasian population. Different angular, linear, and proportional variables were investigated. Descriptive statistics and student t-test were used for data analysis. Results: The distribution of the skeletal relationship revealed that 68.3% of the sample showed class I relationship, 16.1% class II, and 15.6% class III. The result indicates significant differences between the different classes. A greater tendency towards class II facial pattern and more convex profile among Saudis were detected in the present study compared to Caucasians. Furthermore, The dentoalveolar relationship results showed more Bi-maxillary protrusion among Saudi females compared to the North American Caucasians. Conclusion: The results obtained can be of great value in distinguishing the various skeleto-dental features in the different skeletal classes among the Saudi females and in the clinical diagnosis and treatment planning. Furthermore, the results of the study can also serve as a base-line for future investigations in Saudi Arabia.

Background: Using lasers for adhesive restoration removal can be practical and atraumatic. Aims: The purpose of this study was to investigate Er: YAG laser exposure on debonding the adhesive cementation between enamel and feldspar ceramic, lithium disilicate-reinforced and resin nano ceramic composite laminate restorations. Materials and Methods: Vita Cerec Blocs, IPS e.max Computer-aided design (CAD). Computer-aided design and manufacturing (CAD-CAM) in full and Lava Ultimate restorative materials were chosen. The 3 × 3 mm² standardized, 0.5-mm and 1 mm thick specimens were cemented on an enamel surface. After thermocycling, each material group was randomly divided into laser treated and control (non-laser treated) groups. Shear bond strength test was done with a universal testing machine with crosshead speed 0.5 mm/min. Factorial ANOVA Technique and TUKEY HSD multiple comparison test were used for statistical analyses. Moreover, the surface morphology of the debonded samples and the enamel was observed using a scanning electron microscope. Results: The laser application was found to weaken the SBS values significantly (P < 0.05) for all groups; however, the most dramatic SBS decrease was observed for laser treated IPS e.max at both thicknesses. Conclusions: Laser treatment can serve as a practical and effective method that eliminates the risk the enamel damage and restoration fracture.

Aim: To compare the effects of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on oral health-related quality of life (OHQoL) following impacted mandibular third molar (M3) surgery. Patients and Methods: A prospective, randomized study of 50 subjects was designed. Participants were divided equally into the PRP and PRF groups. The OHQoL was assessed using the OHQoL-UK instrument preoperatively and on postoperative days (PODS) 1, 3, and 7. Categorical variables were presented as frequencies and proportions. The linear mixed model analysis was used to determine the effects of PRF and PRP on overall OHQoL with respect to time, treatment, and treatment by time–point interaction. The analysis was also performed for the physical, social, and psychological domains. Results: Fifty subjects were analyzed. The time–point assessment of the overall OHQoL was significant within the PRP and PRF groups (P-values of 0.01 and 0.000002, respectively). The time–point analysis was also significant in both study groups at all domain levels (P < 0.05). A comparison of treatment by time–point interaction for the overall OHQoL between the study groups was insignificant (P = 0.217). Treatment by time–point interaction for OHQoL between the study groups at social and psychological domain levels was insignificant, however, at the physical domain level, PRF had a significantly better effect on OHQoL (P = 0.016). Conclusion: The study showed that the overall OHQoL was not significantly different between the PRP and PRF groups after M3 surgery. However, PRF had a significant influence on OHQoL at the physical domain level.

Background: Midwives have a strategic role to inform, educate, and encourage pregnant women to maintain an active lifestyle during pregnancy. Aim: This study explored a cohort of midwives' perspectives on providing prenatal physical activity education and counseling during pregnancy. Subjects and Methods: Seventeen midwives participated in semistructured interviews which were audio-recorded and transcribed verbatim. A thematic analysis approach was applied to the transcribed qualitative data. Results: Midwives rarely provide physical activity education and counseling to pregnant women, citing lack of knowledge on which physical activity to recommend, and the duration and intensity of the physical activity as reasons. Walking is the only physical activity recommended during antenatal sessions. Barriers to providing physical activity education and counseling include shortage of midwives, busy work responsibilities, nonavailability of exercise equipment, and nonprioritization of antenatal physical activity. The midwives also cited overwhelming work responsibilities resulting in extreme fatigue rendering them hardly able to counsel the women. They advocated for the introduction of exercise classes in antenatal health care and the training of midwives on exercises to improve the uptake of midwives' knowledge regarding prenatal exercise and their engagement with pregnant women during antenatal consultations. Conclusions: The midwives lacked knowledge of physical activity during pregnancy and rarely provided such education and counseling. They advocated the need for training and workshops on maternal physical activity. Our findings suggest that physical activity should be integrated into the midwifery/nursing curriculum to empower midwives and other health providers to offer evidence-based physical activity education and counseling to women during antenatal health care as part of the primary health-care service.

Background: It is important to inform nursing students about stroke and improve their role in the clinic. Aims: We aimed to assess the awareness/knowledge of stroke risk factors and warning signs among nursing students. Therefore, we aimed to assess the awareness/knowledge of stroke risk factors and warning signs among nursing students. Materials and Methods: The descriptive and cross-sectional study was carried out between December 2017 and March 2018 with intern students at the faculty of nursing of a university. The sample consisted of 173 students. The data were collected by researchers using “Student Information Form” and “Information Form about Stroke”. The ethical and institutional permission were obtained to conduct the research. Results: Hypertension (96.5%) for risk factors, weakness (98.8%) for warning signs, blood pressure control (96.5%) for prevention measures were the most commonly identified factors. Approximately half of the students had a good level of awareness/knowledge of risk factors (53.2%) and warning signs (53.8%) for stroke. The majority of students (84.4%) had a good level of awareness/knowledge of prevention measures. Ninety-five percent of the students stated that calling an ambulance would be the first appropriate action. Conclusion: Students had a good knowledge of some of the warning signs and risk factors about stroke. Therefore, it is recommended that this subject should be emphasized more in course contents.

Background: Widening the breadth of dentists' responsibilities to include screening all patients for life-threatening diseases, such as head and neck cancer (HNC), is crucial to improve survival rates and decrease morbidity. Aims: The study aimed to assess the knowledge and behavior of dentists toward screening and managing patients with HNC in Daudi Arabia. Thus, this study aimed to assess the knowledge and behavior of dentists toward screening and managing patients with HNC in Saudi Arabia. Methods: This cross-sectional study comprised a closed-ended electronic questionnaire sent to dentists including general practitioners, specialists, and consultants (n = 723). The e-questionnaire included questions that assessed dentists' behavior and knowledge toward screening and managing patients with HNC. The Chi-square test was used to establish relationships between categorical variables. Results: The response rate was 28.5%. Dentists obtained the dental and medical histories of 74% and 80% of their cases, respectively. Only 55% and 14% of dentists routinely ask their patients about smoking habits and family history of cancer, respectively. Additionally, only 13% and 12% always screen for HNC and were familiar with adjunct HNC screening tools, respectively. Approximately 75% of respondents identified HPV as a risk factor, whereas 54% and 41% identified human immunodeficiency virus (HIV) and poor oral hygiene as risk factors, respectively. Conclusions: There is an apparent lack of essential concepts of the behavior and knowledge in our dental community with respect to screening and managing patients with HNC. More emphasis should be placed on updating information on clinical practices and having dentists familiarize themselves with HNC screening methods and tools. Ultimately, the role of the dentist should include screening and detecting systemic diseases in dental settings.

Background: The Saudi Ministry of Health (MOH) has published detailed guidelines and educational documents about Coronavirus disease 2019 (COVID-19) prevention and infection control. The knowledge of dentists of the reported guidelines is not yet assessed and lack of awareness of these guidelines may have negative implications on dental patients. Aims: The aim of this study is to assess the knowledge of dentists about COVID-19 and the MOH guidelines while treating dental patients in Saudi Arabia. Materials and Method: A cross-sectional study was conducted using an online survey which was sent to a sample of dentists in Saudi Arabia from March to May 2020. Results: A total of 294 dentists with a mean age of (36.9 ± 10.6) years completed the questionnaire. Participants included 157 females and 137 males with a range of professional classification and experience. All of the participants were aware of COVID-19, the nature of the disease, symptoms, modes of transmission and people at higher risk, except for 7.2% who did not report the correct incubation period. All participants agreed that patients and staff should wear a facial mask, use hydroalcoholic hand sanitizer upon arrival. Only 72.4% had knowledge about published guidelines. Infection control training was provided for 53% of the participants and those who had training were more confident to treat patients. Regarding personal protective equipment (PPE), putting on and taking off PPE, 64.6% and 78.6%, respectively, were aware of the guidelines. Conclusion: Dentists in Saudi Arabia had optimal knowledge about COVID-19. However, infection control training is recommended to increase readiness and confidence among dentists.

Aims: We aimed to objectively assess the COVID-19 awareness of the patients requiring dental interventions in our dental clinic by utilizing a newly generated questionnaire, which may serve helpfully in the hard battle against the pandemic in our country. Materials and Methods: This study included 306 volunteer adults who applied to our dental clinic for dental interventions during the early days of COVID-19 outbreak in Turkey. All patients responded to a newly created questionnaire composed of four sections with 19 questions those mostly assessing the social and demographic details; like the participant's age, gender, marital status, education status, medical history, basic dental hygiene habits, occupation, and general information about the COVID-19 infection and its protection methods. Results: The outcomes of 306 participants revealed that their gender, age, and education status showed significant distinctions about the dissemination of coronavirus via dental interventions. Higher education status was linked to a loftier level of social awareness about the COVID-19 infection and its potential associations with dental interventions. It was observed that the participants were unsatisfactorily cautious against the COVID-19 infection and its dissemination pathways in their social environment, particularly in the specific case of systematic diseases and preventive measures. The primary way of obtaining information about the COVID-19 infection was the electronic websites. Conclusion: Deplorably, accentuating the urgent need for further intensive training programs on the relationship between the systemic diseases and COVID-19 infection, and explicit daily care methods in the social environment.

Background: Omphalitis is an important cause of neonatal sepsis (NNS) and mortality. Quantitative estimates of risk of omphalitis-related neonatal death is about 10%–19%. Topical applications of antiseptics have been shown to reduce this risk burden but has not been well investigated. Aim: To demonstrate non-inferiority of methylated spirit to chlorhexidine (CHX) gel for prevention of omphalitis, NNS and mortality at day 28. Methods: This was a randomized, non-inferiority trial of methylated spirit versus CHX gel with 161 and 162 mother–baby pairs, respectively, conducted between July 2017 and May 2018. SPSS version 23.0 was used for data analysis to examine for incidence of omphalitis, time-to-cord separation, NNS and mortality. Relative risk and 95% confidence interval were used as point and interval estimates, respectively, with a non-inferiority margin of 10% set for CHX gel while a P values <0.05 was statistically significant. Results: The median age of newborns was 18 h; (IQR: 8–24) h with the risk of omphalitis being 2% higher with CHX gel compared to methylated spirit (RR = 1.020; 95% CI; 0.988-1.053; P = 0.053). The median times-to-cord separation were 7.0 days (IQR: 2–17) and 7.0 days (IQR: 2–18) for methylated spirit and CHX gel, respectively (mean difference: ‒0.2145; 95% CI = ‒0.9085–0.4759; P = 0.544). There was no difference in the risks of NNS and mortality among those treated with methylated spirit compared to those exposed to CHX gel (RR: 1.0; 95% CI = 0.984–1.017; P = 1.000) and (RR: 1.0; 95% CI = 0.994–1.018; P = 0.986) respectively. Conclusions: There is no evidence that 96% methylated spirit is inferior to 4% CHX gel in preventing neonatal omphalitis; hence, it may be considered a safe and effective alternative where CHX gel is unavailable.

Objective: BRAF mutation is detected in 50–70% of melanomas. The molecular methods used to detect BRAF mutations are 80–90% sensitive, specific, and expensive methods. Immunohistochemistry is a relatively common, rapid, relatively inexpensive method in pathology practice compared to molecular techniques. Aims: We aimed to compare immunohistochemical and molecular methods in our case of malign melanoma in which we investigated BRAF mutation with “real time PCR” method and to investigate the compatibility of molecular test results of BRAF immunohistochemistry results as a preliminary test. Methods: Selected blocks of 30 patients with metastatic melanoma who came to our department for BRAF mutation detection were subjected to real time PCR molecular method and immunohistochemical study was performed with BRAF primer antibody. Results: BRAF mutation was detected by molecular method in 7 of 30 cases (23.33%). Conclusion: In all of these 7 cases, positive immunohistochemical staining was identified (100%). In conclusion, the use of BRAF immunohistochemistry as a screening test in the detection of mutant disease will allow the cost-effective use of molecular testing.

Objective: To evaluate predictive clinical and histopathological risk factors for bladder cancer recurrence in patients who underwent nephroureterectomy for primary upper urinary tract transitional cell carcinoma (TCC). Subjects and Methods: Data of 111 patients, who were diagnosed with upper urinary tract TCC and underwent nephroureterectomy were reviewed A total of 65 patients were included in the study, after excluding 34 patients. Results: Bladder cancer recurrence developed in 20 (30.7%) of the 65 patients under evaluation. The recurrence-free survival rates in the 1^st, 3^rd, and 5^th years were 78.4%, 70.7% and 69.2%, respectively. Lymphovascular invasion and a positive surgical margin were defined as risk factors for bladder cancer recurrence. In addition, patients with multiple tumors and low stage and grade pathology had a high rate of bladder cancer recurrence, although this was not statistically significant. Conclusion: After nephroureterectomy, a careful follow-up is required in terms of bladder tumor recurrence especially in patients with a positive surgical margin, lymphovascular invasion, low-grade tumors, or multifocal tumors.

Gonorrhoea is a sexually transmitted infection (STI) that increases the risk of infection with human immunodeficiency virus (HIV) and causes infertility and urethral stricture. We describe three cases of sexually active men, otherwise stable, who presented with a history of painful micturition and creamy white, urethral discharge. A clinical diagnosis of gonococcal urethritis was made and confirmed by microscopy, culture and 16SrRNA. Antimicrobial susceptibility revealed resistance to all the antimicrobial agents tested including ceftriaxone. A dual therapy was initiated using ceftriaxone and azithromycin, but at a higher dose for the patient with multi-drug resistant (MDR) Neisseria gonorrhoeae. Patients did well and were followed up for 5 months. Contact tracing was done for their sexual partners. While it is also important for healthcare workers to familiarize themselves with current treatment guidelines for gonococcal urethritis, the place of clinical laboratory in the management of STIs, with molecular techniques and the need for surveillance for MDR Neisseria gonorrhoeae cannot be overemphasized.

Patients with high-risk conditions for surgery may benefit from some form of regional block when neuroaxial regional blocks may be life threatening. Despite the increased use of ultrasound-guided peripheral regional blocks internationally, local infiltration and targeted nerve blocks aided by knowledge of anatomical landmarks remain helpful in these two patients presented. A 48-year old woman, presented with bleeding left breast mass, mild respiratory distress, and radiological features of lung metastases (Carcinoma of the breast stage 4). Her American Society of Anesthesiologist risk assessment (ASA) was grade 4. Anesthetic technique was mainly local infiltration and intercostal nerve block with 1% lignocaine (10 mg) and 2.5% bupivacaine (62.5 mg) and a 1 in 100,000 dilution of adrenaline in cardiac position with mild sedation with good analgesia and outcome. Another 24-year-old pregnant woman with dilated cardiomyopathy was being managed by a multidisciplinary team. Her cardiac state deteriorated as pregnancy progressed. Caesarean section was done successfully at 35 weeks gestation under local infiltration and rectus sheath block with local anesthetic agents, sedation, and oxygen masks in the cardiac position with good outcome. The good outcomes in these two patients showed the benefit of peripheral regional blocks in high risk patients. Early recognition of high-risk patients and appropriate anesthetic and clinical assessment with the formulation of right techniques can help salvage lives. This thought is more apt in equipment challenged environments like ours in Nigeria, when resources for ultrasound assisted peripheral nerve blocks are not always available.

Testicular torsion leads to loss of blood supply to the testes due to the twisting of the spermatic cord and its contents, necessitating urgent surgical intervention to salvage the affected testis. Testicular loss from missed diagnosis and delayed referral is preventable, especially when patients present early to first contact health care workers. This makes having the correct diagnostic knowledge for testicular torsion by these first contact healthcare providers a very essential determinant of its overall outcome. Two cases of testicular torsion are presented here. Their diagnoses were missed and referrals were delayed despite presenting within three hours of onset of symptoms. It led to the removal of the affected testis in both patients. This case series emphasizes the need to regard every testicular pain in children and young adults as testicular torsion until proven otherwise and highlights the importance of training the first contact health care providers on recognition and prompt intervention or referral of patients with testicular torsion.